Takács Ildikó, Horváth Szabolcs, Balatonyi Borbála, Jávor Szaniszló, Molnár Agnes, Gáspár Sarolta, Hajós Rebeka, Meczker Agnes, Lantos János, Roth Erzsébet, Wéber György
Pécsi Tudományegyetem, Általános Orvostudományi Kar Sebészeti Oktató és Kutató Intézet, 7624 Pécs, Kodály Zoltán u. 20.
Magy Seb. 2010 Oct;63(5):340-6. doi: 10.1556/MaSeb.63.2010.5.8.
INTRODUCTION/AIM: Laparoscopic ventral hernia repair requires a surgical mesh implanted in intraperitoneal position. The combined, double layer meshes are promising in animal models as well as in human practice. The aim of this study was to compare the biological behaviour of two different textured silicone covered polypropylene mesh.
3 × 4 cm big full thickness defect of the abdominal wall was created in New Zealand White rabbits. The defect was covered in 20 animals with a polypropylene mesh with laminar silicone layer on the visceral surface (LSPP), while the remaining 20 cases the defects were covered with a macroporous textured silicone impregnated polypropylene mesh (MSPP). Intraperitoneal adhesion formation and tissue ingrowth in the meshes were investigated. Immunohistochemistry was used to detect proliferation activity (Ki-67), neovascularization (VEGF), and to visualize mesothelial layer (CK) over the mesh. Scanning electron microscopy was used to investigate the visceral surface of the meshes.
While intraperitoneal adhesion formation showed no difference after 1 week, LSPP mesh induced significantly less adhesions after 21 days. The Ki-67 positivity was significantly lower and the number of the VEGF positive cells increased with time in the MSPP group, this was missing in the LSPP group. The thin neoperitoneum layer was detected over MSPP mesh only with CK antibody.
The material and texture of the mesh are responsible for tissular incorporation which is in accordance with the generated foreign body reaction.
引言/目的：腹腔镜腹疝修补术需要在腹腔内植入手术补片。双层复合补片在动物模型和临床实践中都很有前景。本研究的目的是比较两种不同纹理的硅胶覆盖聚丙烯补片的生物学行为。
在新西兰白兔身上制造3×4厘米大的腹壁全层缺损。20只动物的缺损用在内脏表面带有层状硅胶层的聚丙烯补片（LSPP）覆盖，而其余20例缺损用大孔纹理硅胶浸渍聚丙烯补片（MSPP）覆盖。研究补片的腹腔内粘连形成和组织长入情况。采用免疫组织化学检测增殖活性（Ki-67）、新生血管形成（VEGF），并观察补片上的间皮细胞层（CK）。用扫描电子显微镜观察补片的内脏表面。
虽然1周后腹腔内粘连形成无差异，但LSPP补片在21天后诱导的粘连明显较少。MSPP组中Ki-67阳性率显著降低，VEGF阳性细胞数量随时间增加，而LSPP组未出现这种情况。仅用CK抗体在MSPP补片上检测到薄的新腹膜层。
补片的材料和纹理决定了组织的植入情况，这与所产生的异物反应一致。
