Dasika U K, Widmann W D
Morristown Memorial Hospital Department of Surgery, New Jersey, USA.
Am Surg. 1998 Sep;64(9):817-9; discussion 820.
A method that appears to reduce the rate of adhesion formation between intraperitoneal viscera and prosthetic mesh is the placement of absorbable mesh between nonabsorbable mesh and intraperitoneal viscera. In this study, polyglactin mesh was compared with nonabsorbable polypropylene mesh (Marlex). Forty-seven Sprague-Dawley rats were divided into four groups: 1) control, 2) polyglactin (Vicryl), 3) polypropylene mesh, and 4) polyglactin-lined polypropylene mesh. All rats that underwent mesh placement had midline laparotomy with anastamosis of mesh to fascial borders. Controls underwent midline laparotomy and closure only. Groups were then studied at 1, 2, and 3 months, respectively, to determine the degree of adhesion formation. Gross inspection was performed by a blinded researcher with numerical rank given based on the number of adhesions observed: 0, none; 1, mild; 2, moderate; and 3, severe. The data showed that rats in group 3 (polypropylene only) had significant adhesions at 3 months, with average numerical score of 2.75. Polyglactin and polyglactin/polypropylene groups had similar scores of 1.5 each. Control groups predictably showed little adhesion formation, with average score of 0.25. Based on these data, it is observed that lining polypropylene mesh with absorbable polyglactin mesh can reduce adhesion formation to nonabsorbable mesh. The difference in degree of adhesions is most notable at 3 months. This technique may be an important adjunct to reduce the clinical sequelae of intraperitoneal adhesions.
一种似乎能降低腹腔内脏器与人工补片之间粘连形成率的方法是在不可吸收补片和腹腔内脏器之间放置可吸收补片。在本研究中，将聚乙醇酸补片与不可吸收的聚丙烯补片（Marlex）进行了比较。47只Sprague-Dawley大鼠被分为四组：1）对照组，2）聚乙醇酸（薇乔）组，3）聚丙烯补片组，4）聚乙醇酸衬里聚丙烯补片组。所有接受补片植入的大鼠均行中线剖腹术，并将补片与筋膜边缘吻合。对照组仅行中线剖腹术和缝合。然后分别在1、2和3个月时对各组进行研究，以确定粘连形成的程度。由一名不知情的研究人员进行大体检查，并根据观察到的粘连数量给予数字评分：0分，无粘连；1分，轻度粘连；2分，中度粘连；3分，重度粘连。数据显示，第3组（仅聚丙烯补片组）在3个月时出现明显粘连，平均数字评分为2.75分。聚乙醇酸组和聚乙醇酸/聚丙烯组的评分相似，均为1.5分。对照组不出所料地显示出很少的粘连形成，平均评分为0. .25分。基于这些数据，可以观察到用可吸收的聚乙醇酸补片衬里聚丙烯补片可减少与不可吸收补片的粘连形成。粘连程度的差异在3个月时最为显著。该技术可能是减少腹腔粘连临床后遗症的一项重要辅助手段。
