de Vries Reilingh Tammo S, van Goor Harry, Koppe Manuel J, Bodegom Maarten E, Hendriks Thÿs, Bleichrodt Robert P
Department of Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
J Surg Res. 2007 Jun 1;140(1):27-30. doi: 10.1016/j.jss.2006.08.011.
The use of intra-peritoneal polypropylene mesh (PPM) to repair incisional hernia carries the risk of adhesions and damage to the intra-abdominal viscera. Polyglactin 910 mesh (PGM) is advocated to avoid contact between PPM and the intra-abdominal viscera. An experimental study in rats was performed to determine if interposition of a resorbable prosthesis between the PPM and viscera alters biocompatibility, adhesion formation, and herniation.
A 2- x 3-cm abdominal wall defect was created in 80 rats. Rats were randomly assigned for repair with 2.5- x 3.5-cm PPM (n = 40) or 2.5- x 3.5-cm PPM plus polyglactin 910 mesh (PPM-PGM) (n = 40). The rats were sacrificed at 1, 2, 3, and 6 months (n = 10), and an autopsy was performed to determine herniation and adhesion rates. Mesh-fascia interface was taken for histology.
In the PPM group, 1 rat died before the end of the experiment, and at 6 months one of the 10 rats had a herniation. In the PPM-PGM group, two rats died before the end of the experiment, and two rats had a herniation after 1 month and three rats after 6 months. At 1, 2, and 3 months the adhesion score in the PPM group (median, 3; range, 2-3) did not differ from the score in the PPM-PGM group (median, 3; range, 2-3). Also, at 6 months the adhesion score in the PPM group (median, 2; range, 2-3) did not differ from the score in the PPM-PGM group (median, 3; range, 2-3). At microscopy a capsule was formed around the PP fibers, which matured over months in the PPM group. In the first month after implantation an inflammatory response was seen. Histology was similar in both groups, although in the early PPM-PGM group the inflammatory response was more evident.
Interposition of PGM between PPM and viscera does not alter adhesion formation nor influences herniation rate.
使用腹腔内聚丙烯网片（PPM）修复切口疝存在粘连及损伤腹腔内脏器的风险。提倡使用聚乙醇酸910网片（PGM）以避免PPM与腹腔内脏器接触。进行了一项大鼠实验研究，以确定在PPM与内脏之间置入可吸收假体是否会改变生物相容性、粘连形成及疝形成情况。
在80只大鼠身上制造一个2×3厘米的腹壁缺损。大鼠被随机分配用2.5×3.5厘米的PPM（n = 40）或2.5×3.5厘米的PPM加聚乙醇酸910网片（PPM - PGM）（n = 40）进行修复。在1、2、3和6个月时处死大鼠（n = 10），并进行尸检以确定疝形成率和粘连率。取网片 - 筋膜界面进行组织学检查。
在PPM组，1只大鼠在实验结束前死亡，6个月时10只大鼠中有1只发生疝形成。在PPM - PGM组，2只大鼠在实验结束前死亡，1个月后有2只大鼠发生疝形成，6个月后有3只大鼠发生疝形成。在1、2和3个月时，PPM组的粘连评分（中位数为3；范围为2 - 3）与PPM - PGM组的评分（中位数为3；范围为2 - 3）无差异。同样，在6个月时，PPM组的粘连评分（中位数为2；范围为2 - 3）与PPM - PGM组的评分（中位数为3；范围为2 - 3）无差异。显微镜检查显示，PP纤维周围形成了一个包膜，在PPM组中该包膜在数月内逐渐成熟。植入后的第一个月可见炎症反应。两组的组织学情况相似，尽管在早期PPM - PGM组炎症反应更明显。
在PPM与内脏之间置入PGM不会改变粘连形成，也不会影响疝形成率。
