Fortelny R H, Petter-Puchner A H, Walder N, Mittermayr R, Ohlinger W, Heinze A, Redl H
Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria-Research Center for Traumatology of AUVA, Donaveschingenstr. 13, 1200, Vienna, Austria.
Surg Endosc. 2007 Oct;21(10):1781-5. doi: 10.1007/s00464-007-9243-7. Epub 2007 Mar 14.
Tissue sealants have been proposed as an alternative to permanent fixation devices in hernia repair with the aim of reducing perforation-associated complications and chronic pain. Sealants can be divided into three main categories: synthetic glues (e.g., cyanoacrylate based), biologic products (e.g., fibrin sealant), and genetically engineered polymer protein glues. The beneficial effects of fibrin sealant have been reported in both experimental and clinical hernia repair. However, data on cyanoacrylate glues for mesh sealing are limited.
In 20 Sprague-Dawley rats, two hernia defects (1.5 cm in diameter) per animal were created bilaterally in the midline of the abdominal wall. The peritoneum was spared. The lesions were left untreated for 10 days to achieve a chronic condition. Defects then were covered with TI-Mesh xl (2 x 2 cm), which was glued with Glubran-II. The time points of sacrifice were 17 days, 28 days, and 3 months. At autopsy, meshes were biomechanically tested, and histology was performed.
Tissue integration of the meshes was impaired at all time points by impenetrable glue plaques. At application sites, the elasticity of the abdominal wall was significantly reduced because of nonresorbed, rigid glue residues.
Mesh fixation by Glubran-II impairs tissue integration, elicits inflammation, and unfavorably alters the biomechanics of macroporous mesh and the abdominal wall.
组织密封剂已被提议作为疝修补术中永久固定装置的替代物，目的是减少穿孔相关并发症和慢性疼痛。密封剂可分为三大类：合成胶水（如氰基丙烯酸酯基）、生物制品（如纤维蛋白密封剂）和基因工程聚合物蛋白胶水。纤维蛋白密封剂在实验性和临床疝修补中的有益效果已有报道。然而，关于氰基丙烯酸酯胶水用于补片密封的数据有限。
在20只Sprague-Dawley大鼠中，每只动物在腹壁中线两侧制造两个疝缺损（直径1.5厘米）。保留腹膜。病变不进行处理10天以形成慢性状态。然后用TI-Mesh xl（2×2厘米）覆盖缺损，并用Glubran-II胶水粘贴。处死时间点为17天、28天和3个月。尸检时，对补片进行生物力学测试，并进行组织学检查。
在所有时间点，不可穿透的胶水斑块均损害了补片的组织整合。在应用部位，由于未吸收的刚性胶水残留，腹壁弹性显著降低。
用Glubran-II固定补片会损害组织整合，引发炎症，并对大孔补片和腹壁的生物力学产生不利影响。
