Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcalá, Madrid, Spain.
Networking Biomedical Research Centre on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain.
Surg Endosc. 2022 Jan;36(1):579-590. doi: 10.1007/s00464-021-08320-5. Epub 2021 Jan 28.
When using a prosthetic material in hernia repair, the behaviour of the mesh at the peritoneal interface is especially important for implant success. Biomaterials developed for their intraperitoneal placement are known as composites and are made up of two different-structure materials, one is responsible for good integration within host tissue and the other is responsible to make contact with the viscera. This study examines the behaviour at the peritoneal level of two composites, the fully degradable Phasix-ST® and the partially degradable Symbotex®. A polypropylene mesh (Optilene®) served as control.
Sequential laparoscopy from 3 to 90 days, in a preclinical model in the New Zealand white rabbit, allowed monitoring adhesion formation. Morphological studies were performed to analyse the neoperitoneum formed in the repair process. Total macrophages were identified by immunohistochemical labelling. To identify the different macrophage phenotypes, complementary DNAs were amplified by qRT-PCR using specific primers for M1 (TNF-α/CXCL9) and M2 (MRC1/IL-10) macrophages.
The percentage of firm and integrated adhesions remained very high in the control group over time. Both composites showed a significant decrease in adhesions at all study times and in qualitative terms were mainly loose. Significant differences were also observed from 7 days onwards between the two composites, increasing the values in Phasix over time. Neoperitoneum thickness for Phasix was significantly greater than those of the other meshes, showing mature and organized neoformed connective tissue. Immunohistochemically, a significantly higher percentage of macrophages was observed in Symbotex. mRNA expression levels for the M2 repair-type macrophages were highest for Phasix but significant differences only emerged for IL-10.
Fewer adhesions formed to the Symbotex than Phasix implants. Ninety days after implant, total macrophage counts were significantly higher for Symbotex, yet Phasix showed the greater expression of M2 markers related to the tissue repair process.
在疝修补术中使用假体材料时，网片在腹膜界面的行为对植入物的成功尤为重要。为了在腹腔内使用而开发的生物材料被称为复合材料，由两种不同结构的材料组成，一种负责与宿主组织良好整合，另一种负责与内脏接触。本研究检查了两种复合材料（完全可降解的 Phasix-ST®和部分可降解的 Symbotex®）在腹膜水平的行为。聚丙稀网片（Optilene®）作为对照。
在新西兰白兔的临床前模型中，通过连续腹腔镜检查，监测 3 至 90 天内的粘连形成情况。进行形态学研究以分析修复过程中形成的新腹膜。通过免疫组织化学标记鉴定总巨噬细胞。为了鉴定不同的巨噬细胞表型，使用针对 M1（TNF-α/CXCL9）和 M2（MRC1/IL-10）巨噬细胞的特异性引物，通过 qRT-PCR 扩增互补 DNA。
在对照组中，随着时间的推移，牢固和整合的粘连百分比仍然非常高。两种复合材料在所有研究时间内均显示出粘连的显著减少，且在定性上主要为疏松。从第 7 天开始，两种复合材料之间也观察到显著差异，随着时间的推移，Phasix 的值增加。Phasix 的新腹膜厚度明显大于其他网片，显示出成熟和有组织的新生结缔组织。免疫组织化学染色显示，Symbotex 中的巨噬细胞百分比明显更高。Phasix 中修复型 M2 巨噬细胞的 mRNA 表达水平最高，但仅在 IL-10 方面存在显著差异。
Symbotex 形成的粘连比 Phasix 植入物少。植入 90 天后，Symbotex 的总巨噬细胞计数明显更高，但 Phasix 表现出与组织修复过程相关的 M2 标志物的更大表达。
