脱细胞基质补片修复大鼠腹壁缺损时耐受感染能力的实验研究  

Experimental assessment of the resistance of acellular tissue matrix mesh against infection for infected or contaminated abdominal wall defect in rats

作　　者：李玥[1] 廖芝伟[1] 黄琦[1] 周远航[1] 汤睿[2] 董建[1] 

机构地区：[1]复旦大学附属华山北院宝山分院普外科,上海200431 [2]同济大学附属东方医院疝与腹壁外科

出　　处：《腹部外科》2017年第5期412-415,F0004,共5页Journal of Abdominal Surgery

基　　金：上海市宝山区科委基金项目(2012-E-28)

摘　　要：目的探讨脱细胞异体真皮基质组织补片在污染或感染环境下一期修补大鼠腹壁缺损时耐受感染的能力。方法 60只SD雄性大鼠,随机分为清洁(A组)、污染(B组)、感染组(C组)3组,每组20只,另设空白对照组1只,采用切除全部腹壁肌肉的方式制备腹壁缺损模型,清洁组直接用补片修复缺损;用大肠稀释液涂抹补片、腹壁切口制备污染模型,后一期修补缺损;大肠纵向切开0.3 cm形成肠瘘制备感染模型,然后以脱细胞基质补片一期修复腹壁缺损。术后7 d、14 d各组分别处死一半大鼠,观察切口愈合情况、补片感染情况并取补片及周围组织进行病理检查。结果 A组、B组实验大鼠均无死亡,C组术后1周内死亡4只,均因肠瘘导致弥漫性腹膜炎,腹腔大量积液死亡。术后7 d污染、感染组切口感染率显著高于清洁组(P=0.004);术后14 d各组切口愈合情况差异无统计学意义。组织学观察显示术后7 d污染组炎性反应明显较清洁、污染组严重,而在纤维增生、新生血管形成等方面差异无统计学意义。结论从耐受感染的角度考虑,脱细胞异体真皮基质组织补片可用于一期修补污染或感染状态下腹壁缺损,该补片具有较强的耐受感染能力,其内在机制可能与炎性细胞容易进入补片及早期新生血管形成有关。Objective To investigate the resistance of human acellular tissue matrix mesh against infection for infected or contaminated abdominal wall defect in rats. Methods A total of 61 rats were randomly divided into clean group （group A, n = 20）, contaminated group （group B, n = 20） and infected group （group C, n = 20）. All rats underwent total abdominal wall muscle resection to make the abdominal wall defect model. Additionally, in group B, we used Escherichia coli intestinal juice to contaminate the abdominal wall and patches, and in group C, the colon was incised longitudinally for 0.3 cm to establish infected model. The abdominal defect was then closed with acellular tissue matrix. The healing process of abdominal incision, and the mesh infection state were observed on the day 7 and day 14 after operation, and the specimens were obtained for pathological examination. Results Four rats died during the first 7 days from diffused peritonitis in group C, and no deaths occurred in group A and group B. Seven days after operation, the wound infection rate was significantly higher in groups B and C than in group A （P = 0. 004）, but on the day 14, there was no statistically significant differ- ence among three groups. Pathological examination suggested that the score of inflammatory reaction was higher in group C 7 days after operation, and the scores of proliferating fibroblasts and revascularization showed no significant difference among three groups. Conclusions In terms of the resistance against infection, the acellular tissue matrix mesh was feasible for primary closure of contaminated and infected abdominal wall defects. The potential mechanism may include superior inflammatory cell migration and rapid neovascularization.

关 键 词：污染 感染 腹壁缺损 脱细胞基质 

分 类 号：R657.3[医药卫生—外科学]