<?xml version="1.0" encoding="ISO-8859-1"?><cms:container xmlns:cms="http://edoc.hu-berlin.de/diml/module/cms"><cms:document><cms:meta><cms:entry id="front" part="front" ref="front" type="front"/><cms:entry type="title">Neue Möglichkeiten zur Reduzierung von postoperativen Adhäsionen 
			 Eine vergleichende tierexperimentelle Studie mit abriebarmen Bauchtüchern und Perfluorcarbon PF 5080</cms:entry><cms:entry type="author">Daniel  Grund
         </cms:entry><cms:entry id="N10030" part="front" ref="N10030" type="pagenumber">2</cms:entry><cms:entry id="N1004C" part="front" ref="N1004C" type="pagenumber">3</cms:entry><cms:entry id="N10078" part="front" ref="N10078" type="pagenumber">4</cms:entry><cms:entry id="N100BB" part="front" ref="N100BB" type="pagenumber">5</cms:entry><cms:entry ref="chapter1" type="chapter">1</cms:entry><cms:entry ref="N100C7" type="pagenumber">7</cms:entry><cms:entry id="chapter2" part="chapter2" ref="chapter2" type="chapter">2</cms:entry><cms:entry id="N100F5" part="chapter2" ref="N100F5" type="pagenumber">8</cms:entry><cms:entry id="N100FD" part="chapter2" ref="N100FD" type="section">2.1</cms:entry><cms:entry id="N1010A" part="chapter2" ref="N1010A" type="section">2.2</cms:entry><cms:entry id="N10130" part="chapter2" ref="N10130" type="pagenumber">9</cms:entry><cms:entry id="N10170" part="chapter2" ref="N10170" type="pagenumber">10</cms:entry><cms:entry id="N10187" part="chapter2" ref="N10187" type="subsection">2.2.1</cms:entry><cms:entry id="N101AE" part="chapter2" ref="N101AE" type="pagenumber">11</cms:entry><cms:entry id="N101B2" part="chapter2" ref="N101B2" type="table"/><cms:entry id="N1028A" part="chapter2" ref="N1028A" type="pagenumber">12</cms:entry><cms:entry id="chapter3" part="chapter3" ref="chapter3" type="chapter">3</cms:entry><cms:entry id="N102B5" part="chapter3" ref="N102B5" type="pagenumber">13</cms:entry><cms:entry id="N102BD" part="chapter3" ref="N102BD" type="section">3.1</cms:entry><cms:entry id="N102D6" part="chapter3" ref="N102D6" type="section">3.2</cms:entry><cms:entry id="N1031B" part="chapter3" ref="N1031B" type="section">3.3</cms:entry><cms:entry id="N1031F" part="chapter3" ref="N1031F" type="pagenumber">14</cms:entry><cms:entry id="N10340" part="chapter3" ref="N10340" type="section">3.4</cms:entry><cms:entry id="N10355" part="chapter3" ref="N10355" type="section">3.5</cms:entry><cms:entry id="N10372" part="chapter3" ref="N10372" type="section">3.6</cms:entry><cms:entry id="N1037C" part="chapter3" ref="N1037C" type="pagenumber">15</cms:entry><cms:entry id="chapter4" part="chapter4" ref="chapter4" type="chapter">4</cms:entry><cms:entry id="N103AD" part="chapter4" ref="N103AD" type="section">4.1</cms:entry><cms:entry id="N103B4" part="chapter4" ref="N103B4" type="pagenumber">16</cms:entry><cms:entry id="N103BE" part="chapter4" ref="N103BE" type="section">4.2</cms:entry><cms:entry id="N103EE" part="chapter4" ref="N103EE" type="pagenumber">17</cms:entry><cms:entry id="N103F2" part="chapter4" ref="N103F2" type="table"/><cms:entry id="chapter5" part="chapter5" ref="chapter5" type="chapter">5</cms:entry><cms:entry id="N1069D" part="chapter5" ref="N1069D" type="pagenumber">18</cms:entry><cms:entry id="N106A2" part="chapter5" ref="N106A2" type="section">5.1</cms:entry><cms:entry id="N106CA" part="chapter5" ref="N106CA" type="mm">573#425</cms:entry><cms:entry id="N106D8" part="chapter5" ref="N106D8" type="pagenumber">19</cms:entry><cms:entry id="N1071B" part="chapter5" ref="N1071B" type="pagenumber">20</cms:entry><cms:entry id="N1071F" part="chapter5" ref="N1071F" type="mm">585#435</cms:entry><cms:entry id="N10729" part="chapter5" ref="N10729" type="section">5.2</cms:entry><cms:entry id="N10753" part="chapter5" ref="N10753" type="pagenumber">21</cms:entry><cms:entry id="N10764" part="chapter5" ref="N10764" type="section">5.3</cms:entry><cms:entry id="N10769" part="chapter5" ref="N10769" type="subsection">5.3.1</cms:entry><cms:entry id="N10778" part="chapter5" ref="N10778" type="subsection">5.3.2</cms:entry><cms:entry id="N107A9" part="chapter5" ref="N107A9" type="table"/><cms:entry id="N107F4" part="chapter5" ref="N107F4" type="subsection">5.3.3</cms:entry><cms:entry id="N107FB" part="chapter5" ref="N107FB" type="pagenumber">22</cms:entry><cms:entry id="N10802" part="chapter5" ref="N10802" type="mm">125#41</cms:entry><cms:entry id="N1081E" part="chapter5" ref="N1081E" type="section">5.4</cms:entry><cms:entry id="N10830" part="chapter5" ref="N10830" type="pagenumber">23</cms:entry><cms:entry id="N10834" part="chapter5" ref="N10834" type="table"/><cms:entry id="N10932" part="chapter5" ref="N10932" type="section">5.5</cms:entry><cms:entry id="chapter6" part="chapter6" ref="chapter6" type="chapter">6</cms:entry><cms:entry id="N10941" part="chapter6" ref="N10941" type="section">6.1</cms:entry><cms:entry id="N1094E" part="chapter6" ref="N1094E" type="table"/><cms:entry id="N109E1" part="chapter6" ref="N109E1" type="pagenumber">24</cms:entry><cms:entry id="N109E5" part="chapter6" ref="N109E5" type="mm">585#595</cms:entry><cms:entry id="N109F3" part="chapter6" ref="N109F3" type="pagenumber">25</cms:entry><cms:entry id="N109F7" part="chapter6" ref="N109F7" type="table"/><cms:entry id="N10AF1" part="chapter6" ref="N10AF1" type="table"/><cms:entry id="N10BB2" part="chapter6" ref="N10BB2" type="pagenumber">26</cms:entry><cms:entry id="N10BB6" part="chapter6" ref="N10BB6" type="mm">585#595</cms:entry><cms:entry id="N10BC4" part="chapter6" ref="N10BC4" type="table"/><cms:entry id="N10C82" part="chapter6" ref="N10C82" type="pagenumber">27</cms:entry><cms:entry id="N10C86" part="chapter6" ref="N10C86" type="mm">585#596</cms:entry><cms:entry id="N10C94" part="chapter6" ref="N10C94" type="table"/><cms:entry id="N10D52" part="chapter6" ref="N10D52" type="pagenumber">28</cms:entry><cms:entry id="N10D59" part="chapter6" ref="N10D59" type="mm">586#596</cms:entry><cms:entry id="N10D64" part="chapter6" ref="N10D64" type="pagenumber">29</cms:entry><cms:entry id="N10D6A" part="chapter6" ref="N10D6A" type="section">6.2</cms:entry><cms:entry id="N10D77" part="chapter6" ref="N10D77" type="mm">562#422</cms:entry><cms:entry id="N10D85" part="chapter6" ref="N10D85" type="pagenumber">30</cms:entry><cms:entry id="N10D89" part="chapter6" ref="N10D89" type="mm">562#422</cms:entry><cms:entry id="N10DA0" part="chapter6" ref="N10DA0" type="pagenumber">31</cms:entry><cms:entry id="N10DA7" part="chapter6" ref="N10DA7" type="mm">585#439</cms:entry><cms:entry id="N10DB5" part="chapter6" ref="N10DB5" type="pagenumber">32</cms:entry><cms:entry id="N10DB9" part="chapter6" ref="N10DB9" type="mm">563#430</cms:entry><cms:entry id="N10DC7" part="chapter6" ref="N10DC7" type="mm">563#425</cms:entry><cms:entry id="N10DD5" part="chapter6" ref="N10DD5" type="pagenumber">33</cms:entry><cms:entry id="N10DEB" part="chapter6" ref="N10DEB" type="pagenumber">34</cms:entry><cms:entry id="N10DEF" part="chapter6" ref="N10DEF" type="mm">585#383</cms:entry><cms:entry id="N10DFD" part="chapter6" ref="N10DFD" type="mm">562#422</cms:entry><cms:entry id="N10E0B" part="chapter6" ref="N10E0B" type="pagenumber">35</cms:entry><cms:entry id="N10E0F" part="chapter6" ref="N10E0F" type="mm">562#422</cms:entry><cms:entry id="N10E20" part="chapter6" ref="N10E20" type="pagenumber">36</cms:entry><cms:entry id="N10E27" part="chapter6" ref="N10E27" type="mm">585#439</cms:entry><cms:entry id="N10E38" part="chapter6" ref="N10E38" type="pagenumber">37</cms:entry><cms:entry id="N10E3C" part="chapter6" ref="N10E3C" type="mm">585#439</cms:entry><cms:entry id="N10E50" part="chapter6" ref="N10E50" type="pagenumber">38</cms:entry><cms:entry id="N10E54" part="chapter6" ref="N10E54" type="mm">575#425</cms:entry><cms:entry id="N10E62" part="chapter6" ref="N10E62" type="mm">562#403</cms:entry><cms:entry id="N10E70" part="chapter6" ref="N10E70" type="pagenumber">39</cms:entry><cms:entry id="N10E74" part="chapter6" ref="N10E74" type="mm">562#408</cms:entry><cms:entry id="N10E82" part="chapter6" ref="N10E82" type="mm">562#408</cms:entry><cms:entry id="N10E90" part="chapter6" ref="N10E90" type="pagenumber">40</cms:entry><cms:entry id="N10E94" part="chapter6" ref="N10E94" type="mm">552#394</cms:entry><cms:entry id="N10EA2" part="chapter6" ref="N10EA2" type="mm">552#404</cms:entry><cms:entry id="N10EAF" part="chapter6" ref="N10EAF" type="section">6.3</cms:entry><cms:entry id="N10EB3" part="chapter6" ref="N10EB3" type="pagenumber">41</cms:entry><cms:entry id="N10EBD" part="chapter6" ref="N10EBD" type="mm">578#418</cms:entry><cms:entry id="N10ECB" part="chapter6" ref="N10ECB" type="pagenumber">42</cms:entry><cms:entry id="N10ECF" part="chapter6" ref="N10ECF" type="mm">398#383</cms:entry><cms:entry id="N10EDD" part="chapter6" ref="N10EDD" type="mm">490#392</cms:entry><cms:entry id="N10EEB" part="chapter6" ref="N10EEB" type="pagenumber">43</cms:entry><cms:entry id="N10EEF" part="chapter6" ref="N10EEF" type="mm">489#441</cms:entry><cms:entry id="chapter7" part="chapter7" ref="chapter7" type="chapter">7</cms:entry><cms:entry id="N10F08" part="chapter7" ref="N10F08" type="section">7.1</cms:entry><cms:entry id="N10F0C" part="chapter7" ref="N10F0C" type="pagenumber">44</cms:entry><cms:entry id="N10F23" part="chapter7" ref="N10F23" type="section">7.2</cms:entry><cms:entry id="N10F40" part="chapter7" ref="N10F40" type="pagenumber">45</cms:entry><cms:entry id="N10F4F" part="chapter7" ref="N10F4F" type="section">7.3</cms:entry><cms:entry id="N10F63" part="chapter7" ref="N10F63" type="section">7.4</cms:entry><cms:entry id="N10F7B" part="chapter7" ref="N10F7B" type="pagenumber">46</cms:entry><cms:entry id="N10F81" part="chapter7" ref="N10F81" type="section">7.5</cms:entry><cms:entry id="N10F97" part="chapter7" ref="N10F97" type="pagenumber">47</cms:entry><cms:entry id="N10FA0" part="chapter7" ref="N10FA0" type="section">7.6</cms:entry><cms:entry id="N10FB6" part="chapter7" ref="N10FB6" type="pagenumber">48</cms:entry><cms:entry ref="N10FBE" type="back"/><cms:entry id="N10FC0" part="N10FC0" ref="N10FC0" type="bibliography">
				
				
				Literaturverzeichnis</cms:entry><cms:entry id="OLE_LINK1" part="N10FC0" ref="OLE_LINK1" type="link"/><cms:entry id="OLE_LINK2" part="N10FC0" ref="OLE_LINK2" type="link"/><cms:entry id="N10FCA" part="N10FC0" ref="N10FCA" type="pagenumber">51</cms:entry><cms:entry id="bib3" part="N10FC0" ref="bib3" type="citation"/><cms:entry id="bib10" part="N10FC0" ref="bib10" type="citation"/><cms:entry id="bib11" part="N10FC0" ref="bib11" type="citation"/><cms:entry id="bib1" part="N10FC0" ref="bib1" type="citation"/><cms:entry id="bib2" part="N10FC0" ref="bib2" type="citation"/><cms:entry id="bib4" part="N10FC0" ref="bib4" type="citation"/><cms:entry id="bib5" part="N10FC0" ref="bib5" type="citation"/><cms:entry id="bib6" part="N10FC0" ref="bib6" type="citation"/><cms:entry id="bib7" part="N10FC0" ref="bib7" type="citation"/><cms:entry id="bib8" part="N10FC0" ref="bib8" type="citation"/><cms:entry id="bib9" part="N10FC0" ref="bib9" type="citation"/><cms:entry id="bib12" part="N10FC0" ref="bib12" type="citation"/><cms:entry id="bib13" part="N10FC0" ref="bib13" type="citation"/><cms:entry id="bib14" part="N10FC0" ref="bib14" type="citation"/><cms:entry id="bib15" part="N10FC0" ref="bib15" type="citation"/><cms:entry id="bib16" part="N10FC0" ref="bib16" type="citation"/><cms:entry id="bib17" part="N10FC0" ref="bib17" type="citation"/><cms:entry id="bib18" part="N10FC0" ref="bib18" type="citation"/><cms:entry id="bib19" part="N10FC0" ref="bib19" type="citation"/><cms:entry id="bib20" part="N10FC0" ref="bib20" type="citation"/><cms:entry id="bib21" part="N10FC0" ref="bib21" type="citation"/><cms:entry id="bib22" part="N10FC0" ref="bib22" type="citation"/><cms:entry id="bib25" part="N10FC0" ref="bib25" type="citation"/><cms:entry id="bib24" part="N10FC0" ref="bib24" type="citation"/><cms:entry id="bib26" part="N10FC0" ref="bib26" type="citation"/><cms:entry id="bib27" part="N10FC0" ref="bib27" type="citation"/><cms:entry id="bib28" part="N10FC0" ref="bib28" type="citation"/><cms:entry id="bib29" part="N10FC0" ref="bib29" type="citation"/><cms:entry id="bib30" part="N10FC0" ref="bib30" type="citation"/><cms:entry id="bib31" part="N10FC0" ref="bib31" type="citation"/><cms:entry id="bib32" part="N10FC0" ref="bib32" type="citation"/><cms:entry id="bib33" part="N10FC0" ref="bib33" type="citation"/><cms:entry id="bib34" part="N10FC0" ref="bib34" type="citation"/><cms:entry id="bib35" part="N10FC0" ref="bib35" type="citation"/><cms:entry id="bib36" part="N10FC0" ref="bib36" type="citation"/><cms:entry id="bib37" part="N10FC0" ref="bib37" type="citation"/><cms:entry id="bib38" part="N10FC0" ref="bib38" type="citation"/><cms:entry id="bib39" part="N10FC0" ref="bib39" type="citation"/><cms:entry id="bib40" part="N10FC0" ref="bib40" type="citation"/><cms:entry id="bib41" part="N10FC0" ref="bib41" type="citation"/><cms:entry id="bib42" part="N10FC0" ref="bib42" type="citation"/><cms:entry id="bib43" part="N10FC0" ref="bib43" type="citation"/><cms:entry id="bib44" part="N10FC0" ref="bib44" type="citation"/><cms:entry id="bib45" part="N10FC0" ref="bib45" type="citation"/><cms:entry id="bib46" part="N10FC0" ref="bib46" type="citation"/><cms:entry id="bib47" part="N10FC0" ref="bib47" type="citation"/><cms:entry id="bib48" part="N10FC0" ref="bib48" type="citation"/><cms:entry id="bib49" part="N10FC0" ref="bib49" type="citation"/><cms:entry id="bib50" part="N10FC0" ref="bib50" type="citation"/><cms:entry id="bib51" part="N10FC0" ref="bib51" type="citation"/><cms:entry id="bib52" part="N10FC0" ref="bib52" type="citation"/><cms:entry id="bib53" part="N10FC0" ref="bib53" type="citation"/><cms:entry id="bib54" part="N10FC0" ref="bib54" type="citation"/><cms:entry id="bib55" part="N10FC0" ref="bib55" type="citation"/><cms:entry id="bib56" part="N10FC0" ref="bib56" type="citation"/><cms:entry id="bib57" part="N10FC0" ref="bib57" type="citation"/><cms:entry id="bib58" part="N10FC0" ref="bib58" type="citation"/><cms:entry id="bib59" part="N10FC0" ref="bib59" type="citation"/><cms:entry id="bib60" part="N10FC0" ref="bib60" type="citation"/><cms:entry id="bib61" part="N10FC0" ref="bib61" type="citation"/><cms:entry id="bib62" part="N10FC0" ref="bib62" type="citation"/><cms:entry id="bib63" part="N10FC0" ref="bib63" type="citation"/><cms:entry id="bib64" part="N10FC0" ref="bib64" type="citation"/><cms:entry id="N116B1" part="N116B1" ref="N116B1" type="acknowledgement">
				Danksagung</cms:entry><cms:entry id="N116B5" part="N116B1" ref="N116B5" type="pagenumber">55</cms:entry><cms:entry id="N116DF" part="N116DF" ref="N116DF" type="vita">
				Lebenslauf</cms:entry><cms:entry id="N116E3" part="N116DF" ref="N116E3" type="pagenumber">56</cms:entry><cms:entry id="N116EA" part="N116DF" ref="N116EA" type="table"/><cms:entry id="N11801" part="N11801" ref="N11801" type="declaration">
				Eidesstattliche Erklärung</cms:entry><cms:entry id="N11805" part="N11801" ref="N11805" type="pagenumber">57</cms:entry><cms:entry part="chapter1" type=":current"/><cms:entry type=":lang">de</cms:entry><cms:entry id=":contents" part="front" ref=":contents" type=":contents">Inhaltsverzeichnis</cms:entry><cms:entry type=":help"><url href="http://...">Hilfe</url></cms:entry></cms:meta><cms:content><chapter id="chapter1" label="1">
			<head>
				<pagenumber id="N100C7" label="7" numbering="arabic" start="7"/>Einleitung in die Thematik und Zielstellung </head>
			<p>Eine bekannte Folge von Operationen, vor allem in der abdominellen und gynäkologischen Chirurgie, ist die Bildung von Verwachsungen des Bauchfells.</p>
			<p>Innerhalb weniger Tage nach einer Operation bilden sich feste Adhäsionen zwischen gegenüberliegenden Seiten des Peritoneums. Die Bildung von Verwachsungen nach einer Operation ist so häufig, dass sie vielerorts als lästiges Übel oder gar als Normalität angesehen wird. Dieser Sachverhalt täuscht allerdings über die Tatsache hinweg, dass derartige Verwachsungen oft die Ursache für nicht unerhebliche Beschwerden sind.[<link ref="bib11">3</link>,<link ref="bib4">6</link>]</p>
			<p>Die häufigste Folge solcher Verwachsungen sind Schmerzen, nicht selten auch Infertilität bei Frauen. All zu oft kommt es zum mechanischen Verschluss des Darms, dem lebensbedrohlichen Krankheitsbild des Adhäsionsileus. </p>
			<p>Besondere Bedeutung hat dies in der Kinderchirurgie. Die verschiedensten Fortschritte der Geburtshilfe sowie der Neugeborenenmedizin und das Überleben immer unreiferer Früh- und Neugeborener führen aus den unterschiedlichsten Gründen zu einer deutlichen Zunahme von abdominalchirurgischen Eingriffen auch in dieser Altersgruppe. Besonders die Necrotisierende Enterocolitis, die fokal intestinale Perforation und Mekoniumtransportstörungen führen häufig zu Mehrfacheingriffen. </p>
			<p>Hierbei ist man zunehmend mit dem Problem von Verwachsungen der Bauchorgane und des Bauchfells konfrontiert. Diese erschweren das chirurgische Vorgehen erheblich. In der Konsequenz führen sie zu einer Verlängerung der Operationszeit und erhöhen das Operationsrisiko. An einem Darmverschluss, als weitere Folge von Verwachsungen, versterben Kinder häufiger als Erwachsenen.[23]</p>
			<p>Die Erkenntnisse über Prozesse, die der Heilung des Peritoneums zugrunde liegen, sind noch unvollständig. Allerdings kennt man verschiedene Faktoren, welche die Entstehung von Adhäsionen beeinflussen. Die Entdeckung z.B., dass Talkum von Gummihandschuhen die Bildung von Verwachsungen fördert, führte mittlerweile dazu, Talkum aus den Operationssälen der Kliniken ganz zu verbannen. Eine weitere Erkenntnis, dass der Abrieb von Bauchtüchern aus Baumwolle ähnliche Wirkung zeigt, hat demgegenüber bisher keine Folgen gehabt.[<link ref="bib27">27</link>]</p>
			<p>Dieser Umstand ist ein Ansatz der vorliegenden Arbeit. Sie stellt eine Alternative vor. Es wurden Tücher aus einem Polyester den herkömmlichen Bauchtüchern gegenübergestellt. Des Weiteren wurde die Möglichkeit der Unterdrückung von Adhäsionsbildung mit Perfluorcarbon untersucht. Dies ist im Rahmen eines vergleichenden Tierexperiments an Ratten geschehen.</p>
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