Mayagoitia-González Juan Carlos, Gudiño-Amezcua Luis Manuel, Rivera-Barragán Virgilio, Mellado-Díaz Arturo Vázquez, Díaz-Chávez Emilio Prieto
Centro Especializado en el Tratamiento de Hernias. Hospital Médica Campestre. León, Guanajuato, Mexico.
Cir Cir. 2012 Mar-Apr;80(2):150-6.
Intraperitoneal meshes produce adhesions and intestinal fistula. Composite materials with an antiadherent barrier prevent that complication. There are no studies using gel products in intraperitoneal meshes to keep in contact with viscera.
Two groups of 20 rats each were used. Polypropylene mesh was placed intraperitoneally in both groups adding hyaluronic acid/carboxymethylcellulose gel to the mesh in the study group. At 28 days, rats were sacrificed and evaluated using the Diamond adhesions scale.
There were 20 rats in the study group and 19 rats in the control group (one postoperative death). Control group all had adhesions: six (32%) >50% of the mesh surface. In the study group one rat (5%) showed no adhesions, and in 14 (70%) <25% of the mesh surface. Severity showed strong and cohesive adhesions in 11 (58%) control group rats and thin, avascular adhesions in 11 (55%) study group rats. For density, in the study group there were two rats (10%) where adhesions were released spontaneously by separating the flap. There was mild to moderate traction in 16 (80%) study group rats and six (32%) control group rats. Adhesiolysis with scissors was used in the study group (5%) and in 13 (68%) control group rats (p <0.05).
Hyaluronic acid/carboxymethylcellulose gel appears to be effective in reducing the percentage of adhesions to segments of intraperitoneal mesh implants.
腹膜内补片会产生粘连和肠瘘。带有抗粘连屏障的复合材料可预防该并发症。目前尚无关于在腹膜内补片中使用凝胶产品使其与内脏保持接触的研究。
使用两组大鼠，每组20只。两组均将聚丙烯补片置于腹膜内，研究组在补片上添加透明质酸/羧甲基纤维素凝胶。28天时，处死大鼠并使用戴蒙德粘连评分量表进行评估。
研究组有20只大鼠，对照组有19只大鼠（1只术后死亡）。对照组均有粘连：6只（32%）粘连面积>补片表面的50%。研究组中1只大鼠（5%）未出现粘连，14只（70%）粘连面积<补片表面的25%。粘连严重程度方面，对照组11只大鼠（58%）表现为强而致密的粘连，研究组11只大鼠（55%）表现为薄的、无血管的粘连。粘连密度方面，研究组有2只大鼠（10%）通过掀起皮瓣粘连自发松解。研究组16只大鼠（80%）和对照组6只大鼠（32%）有轻至中度牵拉。研究组5%的大鼠和对照组68%的大鼠使用剪刀进行粘连松解（p<0.05）。
透明质酸/羧甲基纤维素凝胶似乎可有效降低腹膜内补片植入段的粘连百分比。
