Yao Jing, Tian Wen, Li Jia
Department of General Surgery, First Affiliated Hospital, General Hospital of Chinese PLA, Beijing 100048, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2011 Jun;25(6):685-8.
To observe the anti-adhesion and repair effect of 3 composite patches which composed of polylactide-co-caprolactone (PLC), hyaluronic acid (HA), collagen, and polypropylene (PP) mesh repairing abdominal wall defect in rats under contaminated environment, and to investigate the characteristics of 3 composite patches and the feasibility of one-stage repair.
Ninety-three adult male Wistar rats (weighing 150-250 g) were randomly divided into 3 groups (n = 31): PP/PLC composite patches (group A), PP/HA/PLC composite patches (group B), and PP/collagen/PLC composite patches (group C). One rat was selected from each group to prepare the contaminated homogenate of the small intestine. The abdominal wall defect models (1 cm in diameter) were established in other rats, and the defects were repaired with 3 composite patches (1.5 cm in diameter) according to grouping method. At 30, 60, and 90 days postoperatively, the adhesions was observed, and the patch and adjacent tissue was harvested for histological observation.
Six rats died at 10-70 days postoperatively (2 in group A, 3 in group B, and 1 in group C). No wound infection, intestinal obstruction, or hernia occurred in 3 groups. Adhesion was observed between abdominal viscera and the patch, especially intestine, epiploon, and liver. According to the modified Katada criteria, no significant difference in the adhesion score was found among 3 groups at 30 and 60 days (P > 0.05); the adhesion score was significantly lower in group C than in groups A and B at 90 days (P < 0.05). The histological results showed that inflammatory cell infiltration, fibroblasts, secreted collagen, and the residual absorbable material were observed around the patch at 30 days in 3 groups. Decreased inflammatory cell infiltration, increased fibroblasts and residual PLC were observed at 60 days in 3 groups. At 90 days, the fibroblasts became increasingly mature, collagen deposited, the mesothelium formed gradually, and the residual PLC decreased.
In contaminated environment, PP/collagen/PLC composite patch is superior to PP/PLC and PP/HA/ PLC composite patches in aspect of abdominal adhesion and inflammatory reaction, and it is more applicable to one-stage repair of rat abdominal wall defect. But it is necessary to further study in the long-term efficacy and the security of the composite patch.
观察聚丙交酯-共-己内酯（PLC）、透明质酸（HA）、胶原蛋白与聚丙烯（PP）网片组成的3种复合补片在污染环境下修复大鼠腹壁缺损的抗粘连及修复效果，探讨3种复合补片的特性及一期修复的可行性。
93只成年雄性Wistar大鼠（体重150～250 g）随机分为3组（n = 31）：PP/PLC复合补片组（A组）、PP/HA/PLC复合补片组（B组）、PP/胶原蛋白/PLC复合补片组（C组）。每组选1只大鼠制备小肠污染匀浆。其余大鼠建立直径1 cm的腹壁缺损模型，按分组方法用3种复合补片（直径1.5 cm）修复缺损。术后30、60和90 d观察粘连情况，取补片及相邻组织进行组织学观察。
术后10～70 d死亡6只大鼠（A组2只，B组3只，C组1只）。3组均未发生伤口感染、肠梗阻或疝。观察到腹腔脏器与补片之间有粘连，尤其是肠管、大网膜和肝脏。根据改良片田标准，3组在术后30和60 d粘连评分差异无统计学意义（P > 0.05）；术后90 d，C组粘连评分显著低于A组和B组（P < 0.05）。组织学结果显示，术后30 d 3组补片周围均可见炎性细胞浸润、成纤维细胞、分泌的胶原蛋白及残留的可吸收材料。术后60 d 3组炎性细胞浸润减少，成纤维细胞增多，残留PLC增加。术后90 d，成纤维细胞逐渐成熟，胶原蛋白沉积，间皮逐渐形成，残留PLC减少。
在污染环境下，PP/胶原蛋白/PLC复合补片在腹腔粘连及炎症反应方面优于PP/PLC和PP/HA/PLC复合补片，更适用于大鼠腹壁缺损的一期修复。但复合补片的长期疗效及安全性仍需进一步研究。
