Primus Frank E, Young David M, Grenert James P, Harris Hobart W
Department of Surgery, University of California, San Francisco, San Francisco, California.
Department of Pathology, University of California, San Francisco, San Francisco, California.
J Surg Res. 2018 Jul;227:130-136. doi: 10.1016/j.jss.2018.02.026. Epub 2018 Mar 15.
Open abdominal surgery is frequently complicated by the subsequent development of an incisional hernia. Consequently, more than 400,000 incisional hernia repairs are performed each year, adding over $15 billion per year to U.S. health-care expenditures. While the vast majority of studies have focused on improved surgical techniques or prosthetic materials, we examined the use of metallic silver microparticles to prevent incisional hernia formation through enhanced wound healing.
A rodent incisional hernia model was used. Eighty-two rats were randomly placed into two control groups (saline alone and silver microparticles alone), and three experimental groups (0 mg/cm, 2.5 mg/cm, and 25 mg/cm of silver microparticles applied with a fibrin sealant). Incisional hernia incidence and size, tensile strength, and tissue histology were assessed after 28 days.
A significant reduction of both incisional hernia incidence and hernia size was observed between the control groups and 2.5 mg/cm group, and between the control and 25 mg/cm group by nearly 60% and 90%, respectively (P < 0.05). Histological samples showed a noticeable increase in new fibrosis in the treated animals as compared with the controls, whereas the tensile strength between the groups did not differ.
The novel approach of using silver microparticles to enhance wound healing appears to be a safe and effective method to prevent incisional hernias from developing and could herald a new era of medicinal silver use.
开腹手术常常会因随后发生切口疝而变得复杂。因此,每年要进行超过40万例切口疝修补手术,这使得美国医疗保健支出每年增加超过150亿美元。虽然绝大多数研究都集中在改进手术技术或修复材料上,但我们研究了使用金属银微粒通过促进伤口愈合来预防切口疝形成的方法。
采用啮齿动物切口疝模型。82只大鼠被随机分为两个对照组(仅用生理盐水和仅用银微粒)和三个实验组(分别应用0mg/cm、2.5mg/cm和25mg/cm银微粒并结合纤维蛋白密封剂)。28天后评估切口疝的发生率和大小、拉伸强度以及组织组织学情况。
在对照组与2.5mg/cm组之间,以及对照组与25mg/cm组之间,切口疝的发生率和疝的大小均显著降低,分别降低了近60%和90%(P<0.05)。组织学样本显示,与对照组相比,治疗组动物新形成的纤维化明显增加,而各组之间的拉伸强度没有差异。
使用银微粒促进伤口愈合的新方法似乎是预防切口疝发生的一种安全有效的方法,可能预示着药用银使用的新时代。