各種医用材料を用いた心膜癒着防止に関する実験的研究
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概要
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Pericardial adhesions that develop after primary surgery increase the risk during cardiac reoperation. Several materials have been used as pericardial substitutes to facilitate reoperation. In this study, five different materials, equine pericardium, bovine pericardium, porcine pericardium, silicon rubber and expanded polytetrafluoroethylene (EPTFE) surgical membrane, were evaluated experimentally to find a suitable pericardial substitute to prevent pericardial adhesions. In 47 dogs, about a 5 cm by 5 cm piece of the pericardium was excised through a right thoracotomy. The cardiac surface was massaged with dry gauze, and the pericardial defect was closed with a patch after the injection of about 1 ml blood into the pericardial sac. Most materials were implanted for more than 12 months, but some subjects were put to death within 12 months due to malnutrition. At autopsy, the development of adhesions and epicardial reaction were graded as none, minimal, moderate and severe. The patches were also examined histologically. The equine pericardium, the bovine pericardium and the porcine pericardium were found to have higher levels of adhesion and epicardial reaction. There were no significant differences among these three materials. One subject from the porcine pericardium group showed calcification of the patch. Signs of organization were found in these materials histologically. It was suggested that xenopericardiums were not suitable for prevention of pericardial adhesions. The silicon rubber had significantly lower levels of adhesion compared with the equine pericardium, the porcine pericardium and the EPTFE membrane. However this material had the most significant epicardial reaction. So it was considered that silicon rubber was not acceptable in such cases as aortocoronary bypass resurgery. The EPTFE surgical membrane had no superiority for adhesion or epicardial reaction, but it seemed to be useful because no sign of organization was found in this material histologically. We need to continue to look for the ideal substitute which develops no pericardial adhesions and has no epicardial reaction.
- 1988-12-01
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