Koruth Sam, Narayanaswamy Chetty Y V
Dept. of General Surgery, Lourdes Hospital, Kochi, Kerala, 682012, India.
MS Ramaiah Medical College, Bangalore, Karnataka, 560054, India.
Ann Med Surg (Lond). 2017 May 31;19:37-40. doi: 10.1016/j.amsu.2017.05.012. eCollection 2017 Jul.
The need of this study is to assess the role of collagen III in all hernias which include primary inguinal hernias ventral and recurrent abdominal hernias. Collagen type III represents the mechanically instable, less cross-linked collagen synthesized during the early days of wound healing. Quantitative assessment of collagen III in scar tissue on transversalis fascia as tissue obtained from cases operated for various hernias and compared to that of patients operated for abdominal surgeries for indications other than hernia was compared.
In this study we had a total of 90 patients, of which 45 patients underwent mesh repair for the various hernias and 45 patients who underwent laparotomies for various reasons were included as controls. Size of 1 × 1cm transversalis fascia was taken in both subjects and was sent for quantitative assessment using Immunohistochemistry test. All the above cases were randomized as per age,sex,BMI, co morbidities and materials used for repair.
Results were analysed quantitatively and classified into following groups:Based on intensity of staining into Mild, Intermediate and Well stained and based on Quantity of Collagen III into Grade 0---NIL, Grade 1--1-25%, Grade 2-26-50%, Grade 3--51-75%, Grade 4--76-100% (Table 1). In the case group we had 52.4%,35.7% and 11.9% of the cases in Grade 4, Grade 3 and Grade 2 which proved that there was increased presence of Collagen 3, where as 84.4%,4.4% and 11.1% of patients in the control group were classified as Grade 1, Grade 2, Grade 0. For the quantitative study -Chi square test value -81.279 and the p value < 0.001. For the intensity of staining -Chi square test value -57.64 and p value is < 0.001.
This study signifies that ventral, recurrent and primary inguinal hernias are not just caused because of a primary defect but an acquired disorder with respect to collagen distribution.
本研究旨在评估Ⅲ型胶原蛋白在所有疝中的作用，这些疝包括原发性腹股沟疝、腹疝和复发性腹疝。Ⅲ型胶原蛋白代表在伤口愈合早期合成的机械稳定性较差、交联较少的胶原蛋白。对从接受各种疝手术的病例中获取的腹横筋膜瘢痕组织中的Ⅲ型胶原蛋白进行定量评估，并与因非疝指征接受腹部手术的患者的组织进行比较。
本研究共有90例患者，其中45例因各种疝接受了网片修补术，45例因各种原因接受了剖腹手术的患者作为对照组。在两组受试者中均取1×1cm大小的腹横筋膜，送检进行免疫组织化学检测以进行定量评估。所有上述病例均根据年龄、性别、体重指数、合并症和用于修补的材料进行随机分组。
对结果进行定量分析并分为以下几组：根据染色强度分为轻度、中度和重度染色，根据Ⅲ型胶原蛋白的量分为0级——无，1级——1%-25%，2级——26%-50%，3级——51%-75%，4级——76%-100%（表1）。病例组中4级、3级和2级的病例分别占52.4%、35.7%和11.9%，这证明Ⅲ型胶原蛋白的含量增加，而对照组中84.4%、4.4%和11.1%的患者分别被分类为1级、2级、0级。对于定量研究——卡方检验值为81.279，p值<0.001。对于染色强度——卡方检验值为57.64，p值<0.001。
本研究表明，腹疝、复发性疝和原发性腹股沟疝不仅仅是由原发性缺陷引起的，而是一种与胶原蛋白分布有关的后天性疾病。
