Gokmen-Karasu Ayse Filiz, Aydin Serdar, Sonmez Fatma Cavide, Adanir Ilknur, Ilhan Gulsah, Ates Seda
Department of Obstetrics and Gynecology, Medical Faculty, Bezmialem Vakif University, Adnan Menderes Bulvarı (Vatan St.), Fatih, 34093, İstanbul, Turkey.
Department of Pathology, Medical Faculty, Bezmialem Vakif University, Istanbul, Turkey.
Int Urogynecol J. 2017 Nov;28(11):1695-1700. doi: 10.1007/s00192-017-3328-1. Epub 2017 Apr 24.
Peritonization of mesh during sacrohysteropexy is generally advocated to prevent adhesions to the viscera; however, randomized clinical trials are lacking, and peritonization may not be completely possible in a laparoscopic hysteropexy procedure. Our main objective was to describe a basic experimental rat sacrohysteropexy model. We hypothesized that even when peritoneal closure was omitted, using composite mesh would result in less adhesions to the viscera.
Twenty in-bred female virgin Wistar Hannover rats were used in this study. Standardized hysteropexy procedure and adhesion model is described step by step with two different mesh materials: polypropylene and a composite polyester. Mesh was anchored between the posterior cervix and anterior longitudinal ligament of the lumbar vertebrae. Macroscopic adhesion scores and histopathological tissue reaction was investigated.
Macroscopically, the surface area involved in adhesions was similar between groups. However, adhesions in the polypropylene group were more dense, required sharp dissection for lysis, and yielded higher total macroscopic adhesion scores (p < 0.001). Histologically, a more pronounced host inflammatory response was encountered in the polyester group (p < 0.001).
We describe a rat hysteropexy model and a previously established uterine adhesion model. Adhesion scores in the composite mesh group were lower, and bowel involvement was not seen. Our findings are promising, and further research investigating antiadhesive composite mesh use for hysterosacropexy would be appropriate, especially when peritoneal closure is omitted.
骶骨子宫固定术中普遍主张对补片进行腹膜化以防止与内脏粘连；然而，缺乏随机临床试验，并且在腹腔镜子宫固定术过程中可能无法完全实现腹膜化。我们的主要目标是描述一种基本的大鼠骶骨子宫固定术实验模型。我们假设即使不进行腹膜闭合，使用复合补片也会减少与内脏的粘连。
本研究使用了20只近交系未孕雌性Wistar Hannover大鼠。用两种不同的补片材料（聚丙烯和复合聚酯）逐步描述了标准化的子宫固定术过程和粘连模型。补片固定于子宫颈后部和腰椎前纵韧带之间。研究了宏观粘连评分和组织病理学组织反应。
宏观上，各组粘连所涉及的表面积相似。然而，聚丙烯组的粘连更致密，需要锐性分离才能松解，且总宏观粘连评分更高（p < 0.001）。组织学上，聚酯组出现更明显的宿主炎症反应（p < 0.001）。
我们描述了一种大鼠子宫固定术模型和一种先前建立的子宫粘连模型。复合补片组的粘连评分较低，且未见肠管受累。我们的研究结果很有前景，进一步研究将抗粘连复合补片用于骶骨子宫固定术是合适的，尤其是在不进行腹膜闭合时。
