Prasanna Siva, Sekaran Praveen G, Sivakumar Ajay, Govindan Vimal K
General Surgery, PSG Institute of Medical Sciences and Research, Coimbatore, IND.
Cureus. 2023 Aug 14;15(8):e43479. doi: 10.7759/cureus.43479. eCollection 2023 Aug.
Introduction Technical faults are no longer accepted as the sole reason for recurrence following inguinal hernia (InH) repairs. Medical literature has been studied to find any contributing factors and collagen has emerged as a promising marker. Owing to their long half-lives, it has been found to best reflect the process of scarring, which is central to ensuring the formation of a proper fibrous tissue that incorporates the mesh with the abdominal wall. Methods Sixty participants were divided into two groups. The case group were patients diagnosed with InH and the control group had patients undergoing abdominal surgeries for indications other than abdominal wall hernias. A 0.5x0.5cm specimen of skin and transversalis fascia were biopsied and subsequently stained to determine the amount of collagen I and III. Results Collagen I, collagen III and the ratio of collagen I to III was measured. Collagen I was normal in the skin of both groups but decreased in transversalis fascia of cases. Collagen III was found to be normal in transversalis fascia of both cases and controls, but increased in the skin of cases. Ratio of collagen I to III was decreased in both skin and transversalis fascia of cases. Statistical analysis was carried out using an unpaired t-test, non-parametric Mann-Whitney test, ANOVA and chi-square test. Conclusions Our study has reported that in patients with inguinal hernia, collagen III or immature collagen is increased in skin and collagen I or mature collagen is decreased in the transversalis fascia. The ratio of collagen I/III is decreased in both skin and transversalis fascia.
引言
技术失误不再被视为腹股沟疝（InH）修补术后复发的唯一原因。已对医学文献进行研究以寻找任何促成因素，胶原蛋白已成为一个有前景的标志物。由于其半衰期长，已发现它能最好地反映瘢痕形成过程，而瘢痕形成对于确保形成将补片与腹壁结合的合适纤维组织至关重要。
方法
60名参与者被分为两组。病例组为被诊断患有腹股沟疝的患者，对照组为因腹壁疝以外的指征接受腹部手术的患者。取0.5×0.5cm的皮肤和腹横筋膜标本进行活检，随后进行染色以确定I型和III型胶原蛋白的含量。
结果
测量了I型胶原蛋白、III型胶原蛋白以及I型与III型胶原蛋白的比例。两组患者皮肤中的I型胶原蛋白均正常，但病例组腹横筋膜中的I型胶原蛋白减少。发现病例组和对照组腹横筋膜中的III型胶原蛋白均正常，但病例组皮肤中的III型胶原蛋白增加。病例组皮肤和腹横筋膜中I型与III型胶原蛋白的比例均降低。使用非配对t检验、非参数曼 - 惠特尼检验、方差分析和卡方检验进行统计分析。
结论
我们的研究报告称，腹股沟疝患者皮肤中III型胶原蛋白或未成熟胶原蛋白增加，腹横筋膜中I型胶原蛋白或成熟胶原蛋白减少。皮肤和腹横筋膜中I/III型胶原蛋白的比例均降低。
