van't Riet M, Burger J W A, Bonthuis F, Jeekel J, Bonjer H J
Department of General Surgery, Erasmus University Medical Centre Rotterdam-Dijkzigt, Rotterdam, The Netherlands.
Surg Endosc. 2004 Apr;18(4):681-5. doi: 10.1007/s00464-003-9054-4. Epub 2004 Mar 19.
In laparoscopic incisional hernia repair with intraperitoneal mesh, concern exists about the development of adhesions between bowel and mesh, predisposing to intestinal obstruction and enterocutaneous fistulas. The aim of this study was to assess whether the addition of a collagen coating on the visceral side of a polypropylene mesh can prevent adhesion formation to the mesh.
In 58 rats, a defect in the muscular abdominal wall was created, and a mesh was fixed intraperitoneally to cover the defect. Rats were divided in two groups; polypropylene mesh (control group) and polypropylene mesh with collagen coating (Parieten mesh). Seven and 30 days postoperatively, adhesions and amount and strength of mesh incorporation were assessed. Wound healing was studied by microscopy.
With Parieten mesh, the mesh surface covered by adhesions was reduced after 30 days (42% vs 69%, p = 0.01), but infection rate was increased after both 7 (p = 0.001) and 30 days (p = 0.03), compared to the polypropylene group with no mesh infections. If animals with mesh infection were excluded in the analysis, the mesh surface covered by adhesions was reduced after 7 days (21% vs 76%, p = 0.02), as well as after 30 days (21 vs 69%, p < 0.001). Percentage of mesh incorporation was comparable in both groups. Mean tensile strength of mesh incorporation after 30 days was higher with Parieten mesh.
Although the coated Parieten mesh was more susceptible to mesh infection in the current model, a significant reduction of adhesion formation was still seen with the Parieten mesh after 30 days, with comparable mesh incorporation in the abdominal wall.
在腹腔镜切口疝修补术中使用腹腔内补片时，人们担心肠管与补片之间会形成粘连，进而导致肠梗阻和肠皮肤瘘。本研究的目的是评估在聚丙烯补片的脏面添加胶原蛋白涂层是否能防止与补片形成粘连。
在58只大鼠身上制造腹壁肌肉缺损，将补片腹腔内固定以覆盖缺损。大鼠分为两组：聚丙烯补片（对照组）和带胶原蛋白涂层的聚丙烯补片（Parieten补片）。术后7天和30天，评估粘连情况以及补片植入的数量和强度。通过显微镜检查研究伤口愈合情况。
使用Parieten补片时，30天后被粘连覆盖的补片表面减少（42%对69%，p = 0.01），但与无补片感染的聚丙烯组相比，7天（p = 0.001）和30天（p = 0.03）后的感染率均增加。如果在分析中排除有补片感染的动物，7天后（21%对76%，p = 0.02）以及30天后（21%对69%，p < 0.001）被粘连覆盖的补片表面均减少。两组补片植入的百分比相当。30天后，Parieten补片的补片植入平均抗张强度更高。
尽管在当前模型中，带涂层的Parieten补片更容易发生补片感染，但30天后Parieten补片仍能显著减少粘连形成，且在腹壁中的补片植入情况相当。
