Meyer Thomas, Schwarz Karin, Ulrichs Karin, Höcht Burkhard
Pediatric Surgery Unit, Department of Surgery, Zentrum Operative Medizin (ZOM), Oberdürrbacher Strasse 6, 97080, Würzburg, Germany.
Pediatr Surg Int. 2006 Apr;22(4):369-74. doi: 10.1007/s00383-006-1658-z. Epub 2006 Mar 4.
Congenital abdominal wall defects are impressive and dramatic malformations. Common surgical therapy for omphalocele and gastroschisis is to place the herniated viscera back into the abdomen and to close the fascia. Small defects can be closed directly by surgical treatment. In large defects, resorbable and non-resorbable artificial materials are necessary to close the fascia. The aim of this study is to find out whether new biocompatible materials might be suitable for the treatment of such abdominal wall defects. A median laparotomy was performed in young Wistar rats with a body weight of 75-100 g. Then a full thickness defect was created by excising a 1.5 x 2.5 cm segment including fascia, muscles and peritoneum. These defects were then closed by implantation of a PTFE mesh (Dual-Mesh, n = 6), a PPP mesh (Prolene, n = 6) or a new biocompatible mesh (NBM; Lyoplant, n = 6). Each rat was examined daily after treatment. Bodyweight was determined and the possible development of a hernia was monitored. After 6 weeks, the abdomen was opened again. Adhesions to the intestine were measured and the abdominal wall was removed for histological and tensiometric examination. (1) Compared to the untreated controls, all animals showed physiologic growth and normal bodyweight curve. (2) Only in one rat (Prolene) did an abdominal hernia develop. (3) In contrast to PTFE and PPP mesh, NBM showed only minimal adhesion to the intestine. (4) Tensiometry revealed high stability for non-resorbable materials. However, the characteristics of NBM were very similar to untreated abdominal wall. Our initial results indicate that biocompatible materials can also be used for the therapy of congenital abdominal wall defects.
先天性腹壁缺损是令人瞩目的严重畸形。脐膨出和腹裂的常见外科治疗方法是将突出的内脏回纳到腹腔并关闭筋膜。小的缺损可通过手术直接闭合。大的缺损则需要使用可吸收和不可吸收的人工材料来闭合筋膜。本研究的目的是探究新型生物相容性材料是否适用于此类腹壁缺损的治疗。对体重75 - 100克的幼年Wistar大鼠进行正中剖腹术。然后切除一段1.5×2.5厘米包括筋膜、肌肉和腹膜的全层组织，制造全层缺损。这些缺损随后分别通过植入聚四氟乙烯网片（双网片，n = 6）、聚丙烯网片（普理灵，n = 6）或新型生物相容性网片（NBM；利奥普兰，n = 6）来闭合。治疗后每天对每只大鼠进行检查。测定体重并监测是否可能发生疝气。6周后，再次打开腹腔。测量与肠道的粘连情况，并取出腹壁进行组织学和张力测定检查。（1）与未治疗的对照组相比，所有动物均呈现生理性生长且体重曲线正常。（2）仅1只大鼠（普理灵组）发生了腹疝。（3）与聚四氟乙烯网片和聚丙烯网片相比，新型生物相容性网片与肠道的粘连极少。（4）张力测定显示不可吸收材料具有高稳定性。然而，新型生物相容性网片的特性与未处理的腹壁非常相似。我们的初步结果表明，生物相容性材料也可用于先天性腹壁缺损的治疗。
