Junge Karsten, Klinge Uwe, Rosch Raphael, Klosterhalfen Bernd, Schumpelick Volker
Department of Surgery, RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany.
World J Surg. 2002 Dec;26(12):1472-80. doi: 10.1007/s00268-002-6444-z. Epub 2002 Sep 26.
Inguinal hernia repair is one of the most frequently performed operations. Next to conventional techniques, open and laparoscopic tension-free methods using mesh implants to reinforce the abdominal wall are increasingly carried out, even becoming the standard procedure in many countries. Because of the benefits of material-reduced meshes for incisional hernia repair, a new mesh modification for tension-free inguinal hernia repair has been developed. In the present study this new low-weight mesh (Vypro II) made of polypropylene and polyglactin multifilaments was compared to a common heavy-weight polypropylene mesh (Prolene) regarding their functional consequences and the morphologic tissue response. After implantation in rats as an inlay, abdominal wall mobility was recorded by three-dimensional photogrammetry and the tensile strength of the suture zone and the mesh itself was measured at 3, 21, and 90 days. Explanted tissue samples have been investigated for their histologic reaction in regard to the inflammatory infiltrate, vascularization, and connective and fat tissue ingrowth. Numbers of granulocytes, macrophages, fibroblasts, lymphocytes, and foreign giant body cells have been evaluated to reflect the quality of the tissue response. The cellular response was assessed by measuring DNA strand breaks and apoptosis (TUNEL), proliferation (Ki67), and cell stress (HSP70). The results indicated that restriction of abdominal wall mobility was significantly reduced with Vypro II compared to that seen with heavy-weight mesh modification, and the inflammatory reaction and connective tissue formation were markedly diminished. Apoptosis and cell proliferation showed considerably lowered levels, and expression of cytoprotective HSP70 was significantly increased. The present study thus confirms the benefits of material-reduced mesh modifications. The new low-weight mesh (Vypro II) could be advantageous in inguinal hernia repair.
腹股沟疝修补术是最常施行的手术之一。除了传统技术外，使用网状植入物加强腹壁的开放和腹腔镜无张力方法越来越多地被采用，甚至在许多国家成为标准术式。由于材料减少的补片对切口疝修补有益，一种用于无张力腹股沟疝修补的新型补片改良方法已被开发出来。在本研究中，将这种由聚丙烯和聚乙交酯复丝制成的新型低重量补片（Vypro II）与一种常见的重重量聚丙烯补片（普理灵）在功能后果和形态学组织反应方面进行了比较。将补片作为嵌体植入大鼠体内后，通过三维摄影测量腹壁活动度，并在3天、21天和90天时测量缝合区和补片本身的拉伸强度。对取出的组织样本进行了组织学反应研究，包括炎性浸润、血管生成以及结缔组织和脂肪组织长入情况。评估了粒细胞、巨噬细胞、成纤维细胞、淋巴细胞和异物巨细胞的数量，以反映组织反应的质量。通过测量DNA链断裂和凋亡（TUNEL法）、增殖（Ki67）和细胞应激（HSP70）来评估细胞反应。结果表明，与重重量补片改良相比，Vypro II补片导致的腹壁活动度受限明显减少，炎症反应和结缔组织形成也明显减轻。凋亡和细胞增殖水平显著降低，细胞保护蛋白HSP70的表达显著增加。本研究因此证实了材料减少的补片改良的益处。这种新型低重量补片（Vypro II）在腹股沟疝修补中可能具有优势。
