Ai Fang-Fang, Mao Meng, Zhang Ye, Kang Jia, Zhu Lan
Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, No.1 Shuai Fu Road, Dongcheng District, Beijing, People's Republic of China.
Department of Obstetrics and Gynecology, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China.
Int Urogynecol J. 2020 Jan;31(1):79-89. doi: 10.1007/s00192-019-03947-4. Epub 2019 Apr 17.
Most synthetic meshes used in transvaginal surgery are made of polypropylene, which has a stable performance, but does not easily degrade in vivo. However, mesh-related complications are difficult to address and have raised serious concerns. A new biomaterial mesh with good tissue integration and few mesh-related complications is needed. To evaluate the effect of a new bacterial cellulose (BC) mesh on pelvic floor reconstruction following implantation in the vagina of sheep after 1 and 12 weeks.
The meshes were implanted in the submucosa of the posterior vagina wall of sheep. At 1 and 12 weeks after surgery, mesh-tissue complex (MTC) specimens were harvested for histological studies and biomechanical evaluation. At 12 weeks after surgery, MTC specimens were biomechanically assessed by a uniaxial tension "pulley system".
The BC mesh elicited a higher inflammatory response than Gynemesh™PS at both 1 and 12 weeks after implantation. Twelve weeks after implantation, the BC mesh resulted in less fibrosis than Gynemesh™PS. Compared with the Gynemesh™PS group, the BC mesh group had increased mRNA expression of MMP-1, MMP-2, and MMP-9 (P < 0.05), but decreased expression of the anti-inflammatory factor IL-4 (P < 0.05). Twelve weeks after implantation, the ultimate load and maximum elongation percentage of the BC mesh were significantly lower than those of Gynemesh™PS.
The BC mesh could not be a promising biomaterial for pelvic floor reconstructive surgery unless the production process and parameters were improved.
大多数经阴道手术中使用的合成网片由聚丙烯制成，其性能稳定，但在体内不易降解。然而，与网片相关的并发症难以处理，已引起严重关注。需要一种具有良好组织整合性且与网片相关并发症较少的新型生物材料网片。为评估新型细菌纤维素（BC）网片在植入绵羊阴道1周和12周后对盆底重建的效果。
将网片植入绵羊阴道后壁黏膜下层。术后1周和12周，采集网片 - 组织复合物（MTC）标本进行组织学研究和生物力学评估。术后12周，通过单轴拉伸“滑轮系统”对MTC标本进行生物力学评估。
植入后1周和12周，BC网片引发的炎症反应均高于Gynemesh™PS。植入12周后，BC网片导致的纤维化程度低于Gynemesh™PS。与Gynemesh™PS组相比，BC网片组MMP - 1、MMP - 2和MMP - 9的mRNA表达增加（P < 0.05），但抗炎因子IL - 4的表达降低（P < 0.05）。植入12周后，BC网片的极限载荷和最大伸长百分比显著低于Gynemesh™PS。
除非改进生产工艺和参数，否则BC网片不可能成为盆底重建手术中有前景的生物材料。
