Klosterhalfen B, Klinge U, Schumpelick V
The Institute of Pathology, The Technical University of Aachen, Germany.
Biomaterials. 1998 Dec;19(24):2235-46. doi: 10.1016/s0142-9612(98)00115-x.
Modern surgical hernia repair depends increasingly on synthetic meshes for the reconstruction of the abdominal wall. Despite the undisputed advantages of the polypropylene (PP) meshes currently available (Marlex, Prolene), reports of complications after implantation are increasing. Although, serious complications such as perforation and fistula formation are rare, minor and local complaints such as seromas, misfeelings and a decreased abdominal wall mobility are observed in about one-half of the patients. In regard to the exaggerated strength of the currently available mesh modifications a reduction of the material should improve the integration of the meshes into the artificial abdominal wall. In the present study, the commercially available basic mesh Prolene has been compared to two newly constructed PP-mesh modifications with reduced amounts of PP. The modifications have gradually been adopted to the physiological requirements of abdominal wall stability and mobility by reducing the amount of PP to 64% (E-BLUE) and 24% (variant A) of the Prolene mesh (developed by ETHICON, Norderstedt, Germany). All PP-mesh variants have been implanted in a rat model and studied by 3D-photogrammetry, tensiometry, light- and electron microscopy, as well as morphometry over implantation intervals of 3, 7, 14, 21 and 90 days. The data show that current constructions of PP-meshes are oversized and definitely restrict abdominal wall mobility in the present model. Sufficient stability of the artificial abdominal wall is even guaranteed by PP-mesh modifications with a reduction of PP-quantity to about 25% of the Prolene mesh. The degree of fibrosis directly correlated with abdominal wall restriction, whereas the formation of connective tissue in the interface PP-fibre/host-issue depends on the amount and activity of the inflammatory reaction. The quantity and quality of inflammation, again, directly relies to the amount of PP and to the surface area in contact with the recipient tissues. Altogether, the present study suggests that a modification of the PP-meshes could be helpful to prevent major and minor complications of surgical PP-meshes.
现代外科疝修补术越来越依赖合成补片来重建腹壁。尽管目前可用的聚丙烯（PP）补片（Marlex、Prolene）具有无可争议的优势，但植入后并发症的报告却在增加。虽然穿孔和瘘管形成等严重并发症很少见，但约一半的患者会出现血清肿、感觉异常和腹壁活动度降低等轻微局部不适。鉴于目前可用的补片改良产品强度过大，减少材料用量应能改善补片与人工腹壁的整合。在本研究中，将市售的基础补片Prolene与两种新构建的PP补片改良产品进行了比较，这两种改良产品的PP用量减少。通过将PP用量减少至Prolene补片的64%（E - BLUE）和24%（变体A），逐渐使改良产品适应腹壁稳定性和活动度的生理需求（由德国诺德施泰特的ETHICON公司研发）。所有PP补片变体均植入大鼠模型，并通过三维摄影测量、张力测量、光学和电子显微镜以及形态测量，在3、7、14、21和90天的植入间隔期进行研究。数据表明，目前PP补片的结构尺寸过大，在当前模型中肯定会限制腹壁活动度。即使将PP用量减少至Prolene补片的约25%的PP补片改良产品也能保证人工腹壁有足够的稳定性。纤维化程度与腹壁受限直接相关，而PP纤维/宿主组织界面处结缔组织的形成取决于炎症反应的程度和活性。炎症的数量和质量又直接取决于PP的用量以及与受体组织接触的表面积。总之，本研究表明PP补片的改良可能有助于预防外科PP补片的主要和次要并发症。
