Gandhi Sanjay, Kubba Lena M, Abramov Yoram, Botros Sylvia M, Goldberg Roger P, Victor Thomas A, Sand Peter K
Evanston Continence Center, Northwestern University Feinberg School of Medicine, Ill, USA.
Am J Obstet Gynecol. 2005 May;192(5):1643-8. doi: 10.1016/j.ajog.2004.11.044.
The purpose of this study was to examine the histopathologic changes of HMDI (Hexamethylene di-isocyanate) cross-linked porcine dermis grafts used for suburethral sling surgery.
Twelve patients underwent reoperation with graft removal for urinary retention or recurrent stress urinary incontinence after transvaginal sling surgery. Tissue specimens were available for pathologic evaluation in 7 patients. Graft specimens underwent histologic preparation including hematoxylin and eosin staining. A single pathologist reviewed the slides blinded to clinical outcomes.
Histopathologic analyses revealed only limited collagen remodeling, and evidence of a foreign body type reaction was present in some specimens. In cases of recurrent stress incontinence, implants appeared to be completely replaced by dense fibroconnective tissue and moderate neovascularization without evidence of inflammation or graft remnants.
HMDI cross-linked porcine dermal collagen implants result in variable tissue reactions that may have unpredictable clinical outcomes in different patients, raising questions about the overall tolerability and efficacy of these grafts in pelvic reconstructive surgery.
本研究旨在检查用于尿道下吊带手术的六亚甲基二异氰酸酯（HMDI）交联猪真皮移植物的组织病理学变化。
12例患者在经阴道吊带手术后因尿潴留或复发性压力性尿失禁接受了移除移植物的再次手术。7例患者的组织标本可用于病理评估。移植物标本进行了包括苏木精和伊红染色在内的组织学制备。由一名病理学家在对临床结果不知情的情况下查看切片。
组织病理学分析显示只有有限的胶原重塑，并且在一些标本中存在异物型反应的证据。在复发性压力性尿失禁的病例中，植入物似乎完全被致密的纤维结缔组织和中度新生血管替代，没有炎症或移植物残余的证据。
HMDI交联猪真皮胶原植入物会导致不同的组织反应，在不同患者中可能产生不可预测的临床结果，这引发了对这些移植物在盆腔重建手术中的总体耐受性和疗效的质疑。
