丁國飛 1 , 田文 1 , 姚京 2 , 李佳 1 , 鄭亞杰 1 , 楊松 1
  • 1.中國人民解放軍總醫(yī)院普外科(北京 100853);;
  • 2.中國人民解放軍總醫(yī)院第一附屬醫(yī)院普外科(北京 100857);

目的觀察三種新型國產(chǎn)復合補片修補腹壁缺損的效果，客觀評價三種補片的防粘連效果。方法Wistar大鼠120只，采用完全隨機方法隨機分為4組: ①聚丙烯(PP)+聚丙交己內(nèi)酯(PLC)組; ②PP+透明質(zhì)酸(HA)/PLC組; ③PP+膠原/PLC組; ④PP+膨體聚四氟乙烯(e-PTFE)組，每組30只。切除直徑約1 cm的大鼠全層腹壁，以直徑1.5 cm的補片進行修補，分別于術(shù)后30、60、90及180 d處死，每次處死5只，根據(jù)Nair評分標準進行粘連評分，并進行組織學檢查。結(jié)果術(shù)后各組大鼠均未出現(xiàn)死亡，在各時間點均出現(xiàn)腹腔粘連，主要為網(wǎng)膜、腸管。術(shù)后各時間點，PP+膠原/PLC組粘連評分均低于PP+e-PTFE組(P lt;0.05)。PP+HA/PLC組和PP+PLC組粘連評分與PP+e-PTFE組相比差異無統(tǒng)計學意義(P gt;0.05)。組織學檢查顯示，術(shù)后各時間點，各組補片周圍均有炎性細胞浸潤和成纖維細胞出現(xiàn)及膠原分泌，隨時間推移炎癥細胞逐漸減少，成纖維細胞逐漸增多，膠原分泌增多。術(shù)后30 d 膠原及HA層消失，PLC層出現(xiàn)斷裂，在術(shù)后180 d PLC層尚未被完全吸收，在4種補片腹腔面均有細胞或組織覆蓋，將補片與腹腔內(nèi)容物隔離，膠原/PLC復合補片的隔離層的連續(xù)性最好。結(jié)論PLC、HA/PLC和膠原/PLC三種國產(chǎn)復合補片在動物實驗中均具有良好的防粘連效果，其中膠原/PLC復合補片的防粘連效果最佳，且價格低廉，適于大眾普遍使用，臨床應(yīng)用前景良好。

引用本文： 丁國飛,田文,姚京,李佳,鄭亞杰,楊松. 三種新型復合材料修補大鼠腹壁缺損的研究. 中國普外基礎(chǔ)與臨床雜志, 2011, 18(10): 1049-1053. doi: 復制

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2. 楊曉旭, 魯建國, 陸美嬌, 等. 聚丙烯補片與脫細胞真皮基質(zhì)補片及傳統(tǒng)方法修復戰(zhàn)傷性腹壁軟組織缺損的比較 [J]. 中國組織工程與臨床康復, 2009, 13(29): 56535656.
3. Rohrich RJ, Reagan BJ, Adams WP, et al. Early results of vermilion lip augmentation using acellular allogeneic dermis: an adjunct in facial rejuvenation [J]. Plast Reconstr Surg, 2000, 105(1): 409416.
4. Clayman MA, Clayman LZ. Use of AlloDerm as a barrier to treat chronic Frey’s syndrome [J]. Otolaryngol Head Neck Surg, 2001, 124(6): 687.
5. Choe JM, Kothandapani R, James L, et al. Autologous, cadaveric, and synthetic materials used in sling surgery: comparative biomechanical analysis [J]. Urology, 2001, 58(3): 482486.
6. Silverman RP, Li EN, Holton LH 3rd, et al. Ventral hernia repair using allogenic acellular dermal matrix in a swine model [J]. Hernia, 2004, 8(4): 336342.
7. 中華人民共和國科學技術(shù)部. 關(guān)于善待實驗動物的指導性意見 [Z]. 2007: 20062009.
8. Nair SK, Bhat IK, Aurora AL. Role of proteolytic enzyme in the prevention of postoperative intraperitoneal adhesions [J]. Arch Surg, 1974, 108(6): 849853.
9. Gaertner WB, Bonsack ME, Delaney JP. Visceral adhesions to hernia prostheses [J]. Hernia, 2010, 14(4): 375381.
10. Baptista ML, Bonsack ME, Felemovicius I, et al. Abdominal adhesions to prosthetic mesh evaluated by laparoscopy and electron microscopy [J]. J Am Coll Surg, 2000, 190(3): 271280.
11. Asano T, Takazawa R, Yamato M, et al. Transplantation of an autologous mesothelial cell sheet prepared from tunica vaginalis prevents postoperative adhesions in a canine model [J]. Tissue Eng, 2006, 12(9): 26292637.
12. Bauer JJ, Salky BA, Gelernt IM, et al. Repair of large abdominal wall defects with expanded polytetrafluoroethylene (PTFE) [J]. Ann Surg, 1987, 206(6): 765769.
13. Matthews BD, Pratt BL, Pollinger HS, et al. Assessment of adhesion formation to intraabdominal polypropylene mesh and polytetrafluoroethylene mesh [J]. J Surg Res, 2003, 114(2): 126132.
14. 李基業(yè). 疝修補材料類型及有關(guān)并發(fā)癥 [J]. 臨床外科雜志, 2006, 11(11): 687689.
15. 凌沛學, 管華詩. 透明質(zhì)酸及其衍生物防粘連的研究與應(yīng)用 [J]. 中國藥學雜志, 2005, 40(20): 15271530.
16. Chen WY, Abatangelo G. Functions of hyaluronan in wound repair [J]. Wound Repair Regen, 1999, 7(2): 7989.
17. 張仲文, 徐莘香, 周莉, 等. 聚己內(nèi)酯/聚乳酸薄膜防治肌腱粘連的實驗研究 [J]. 中華骨科雜志, 1998, 11(11): 692694.
18. 張廣明. 生物可降解聚乳酸己內(nèi)酯無規(guī)共聚物輸尿管支架管的制備及實驗研究 [D]. 四川大學, 2006: 1520.
19. Kaleya RN. Evaluation of implant/host tissue interactions following intraperitoneal implantation of porcine dermal collagen prosthesis in the rat [J]. Springer Paris, 2005, 3(9): 269276.
20. PetterPuchner AH, Fortelny RH, Glaser KS, et al. Collagen implants in inguinal and ventral hernia repair [J]. J Invest Surg, 2010, 23(5): 280284.
21. Parker DM, Armstrong PJ, Frizzi JD, et al. Porcine dermal collagen (permacol) for abdominal wall reconstruction [J]. Curr Surg, 2006, 63(4): 255258.
22. van’t Riet M, de Vos van Steenwijk PJ, Bonthuis F, et al. Prevention of adhesion to prosthetic mesh: comparison of different barriers using an incisional hernia model [J]. Ann Surg, 2003, 237(1): 123128.
23. Greenawalt KE, Butler TJ, Rowe EA, et al. Evaluation of sepramesh biosurgical composite in a rabbit hernia repair model [J]. J Surg Res, 2000, 94(2): 9298.
24. Ferrando JM, Vidal J, Armengol M, et al. Experimental evaluation of a new layered prosthesis exhibiting a low tensile modulus of elasticity: longterm integration response within the rat abdominal wall [J]. World J Surg, 2002, 26(4): 409415.
  1. 1. Matthews BD, Pratt BL, Pollinger HS, et al. Assessment of adhesion formation to intraabdominal polypropylene mesh and polytetrafluoroethylene mesh [J]. J Surg Res, 2003, 114(2): 126132.
  2. 2. 楊曉旭, 魯建國, 陸美嬌, 等. 聚丙烯補片與脫細胞真皮基質(zhì)補片及傳統(tǒng)方法修復戰(zhàn)傷性腹壁軟組織缺損的比較 [J]. 中國組織工程與臨床康復, 2009, 13(29): 56535656.
  3. 3. Rohrich RJ, Reagan BJ, Adams WP, et al. Early results of vermilion lip augmentation using acellular allogeneic dermis: an adjunct in facial rejuvenation [J]. Plast Reconstr Surg, 2000, 105(1): 409416.
  4. 4. Clayman MA, Clayman LZ. Use of AlloDerm as a barrier to treat chronic Frey’s syndrome [J]. Otolaryngol Head Neck Surg, 2001, 124(6): 687.
  5. 5. Choe JM, Kothandapani R, James L, et al. Autologous, cadaveric, and synthetic materials used in sling surgery: comparative biomechanical analysis [J]. Urology, 2001, 58(3): 482486.
  6. 6. Silverman RP, Li EN, Holton LH 3rd, et al. Ventral hernia repair using allogenic acellular dermal matrix in a swine model [J]. Hernia, 2004, 8(4): 336342.
  7. 7. 中華人民共和國科學技術(shù)部. 關(guān)于善待實驗動物的指導性意見 [Z]. 2007: 20062009.
  8. 8. Nair SK, Bhat IK, Aurora AL. Role of proteolytic enzyme in the prevention of postoperative intraperitoneal adhesions [J]. Arch Surg, 1974, 108(6): 849853.
  9. 9. Gaertner WB, Bonsack ME, Delaney JP. Visceral adhesions to hernia prostheses [J]. Hernia, 2010, 14(4): 375381.
  10. 10. Baptista ML, Bonsack ME, Felemovicius I, et al. Abdominal adhesions to prosthetic mesh evaluated by laparoscopy and electron microscopy [J]. J Am Coll Surg, 2000, 190(3): 271280.
  11. 11. Asano T, Takazawa R, Yamato M, et al. Transplantation of an autologous mesothelial cell sheet prepared from tunica vaginalis prevents postoperative adhesions in a canine model [J]. Tissue Eng, 2006, 12(9): 26292637.
  12. 12. Bauer JJ, Salky BA, Gelernt IM, et al. Repair of large abdominal wall defects with expanded polytetrafluoroethylene (PTFE) [J]. Ann Surg, 1987, 206(6): 765769.
  13. 13. Matthews BD, Pratt BL, Pollinger HS, et al. Assessment of adhesion formation to intraabdominal polypropylene mesh and polytetrafluoroethylene mesh [J]. J Surg Res, 2003, 114(2): 126132.
  14. 14. 李基業(yè). 疝修補材料類型及有關(guān)并發(fā)癥 [J]. 臨床外科雜志, 2006, 11(11): 687689.
  15. 15. 凌沛學, 管華詩. 透明質(zhì)酸及其衍生物防粘連的研究與應(yīng)用 [J]. 中國藥學雜志, 2005, 40(20): 15271530.
  16. 16. Chen WY, Abatangelo G. Functions of hyaluronan in wound repair [J]. Wound Repair Regen, 1999, 7(2): 7989.
  17. 17. 張仲文, 徐莘香, 周莉, 等. 聚己內(nèi)酯/聚乳酸薄膜防治肌腱粘連的實驗研究 [J]. 中華骨科雜志, 1998, 11(11): 692694.
  18. 18. 張廣明. 生物可降解聚乳酸己內(nèi)酯無規(guī)共聚物輸尿管支架管的制備及實驗研究 [D]. 四川大學, 2006: 1520.
  19. 19. Kaleya RN. Evaluation of implant/host tissue interactions following intraperitoneal implantation of porcine dermal collagen prosthesis in the rat [J]. Springer Paris, 2005, 3(9): 269276.
  20. 20. PetterPuchner AH, Fortelny RH, Glaser KS, et al. Collagen implants in inguinal and ventral hernia repair [J]. J Invest Surg, 2010, 23(5): 280284.
  21. 21. Parker DM, Armstrong PJ, Frizzi JD, et al. Porcine dermal collagen (permacol) for abdominal wall reconstruction [J]. Curr Surg, 2006, 63(4): 255258.
  22. 22. van’t Riet M, de Vos van Steenwijk PJ, Bonthuis F, et al. Prevention of adhesion to prosthetic mesh: comparison of different barriers using an incisional hernia model [J]. Ann Surg, 2003, 237(1): 123128.
  23. 23. Greenawalt KE, Butler TJ, Rowe EA, et al. Evaluation of sepramesh biosurgical composite in a rabbit hernia repair model [J]. J Surg Res, 2000, 94(2): 9298.
  24. 24. Ferrando JM, Vidal J, Armengol M, et al. Experimental evaluation of a new layered prosthesis exhibiting a low tensile modulus of elasticity: longterm integration response within the rat abdominal wall [J]. World J Surg, 2002, 26(4): 409415.