体外和比格犬体内评价腹内压致生物补片分层及疝复发风险的研究  

Delamination of biologic mesh due to intra-abdominal pressure and risk assessment of hernia recurrence in vitro and in Beagle dog model

作　　者：王虞鹭 代京 程文悦 徐隽雅 张剑 Yulu Wang;Jing Dai;Wenyue Cheng;Junya Xu;Jian Zhang(Department of Anorectal Surgery,the Second Affiliated Hospital of Naval Medical University(Shanghai Changzheng Hospital),Shanghai 200003,China)

机构地区：[1]海军军医大学第二附属医院(上海长征医院)肛肠外科,上海200003

出　　处：《中华疝和腹壁外科杂志（电子版）》2024年第2期146-153,共8页Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition)

基　　金：国防科技卓越青年科学基金(2019-JCJQ-ZQ-002);国防科技基础加强计划(2019-JCJQ-JJ-069)。

摘　　要：目的评估模拟腹内压力对生物疝修补补片分层性能的影响及全层腹壁肌缺损比格犬体内植入修补术后的疝复发风险。方法选择两种市售生物疝修补补片作为样本[基底膜与小肠黏膜下层复合细胞外基质补片(BM/SIS复合补片)和小肠黏膜下层补片(SIS补片)],模拟腹腔内生物补片持续受力的环境,在生理盐水中分别对补片进行20000次循环机械拉伸(拉伸率设置为:±10%和±20%),以研究力学加载对补片分层性能的影响。选择4只比格犬,切除整个腹壁组织进行全层腹壁肌缺损造模,并采用不同(BM/SIS、SIS)生物补片进行修补,术后比格犬均饲养2周后处死,取出补片以及周围组织,观察补片植入动物体内后的分层和疝复发现象。结果经过20000次循环机械拉伸后,BM/SIS复合补片未见明显分层和厚度变化;全层腹壁肌缺损比格犬体内植入后组织修复效果较好,未见疝复发。SIS补片在±10%循环机械拉伸下层间距增加,厚度显著增加(P=0.007);在±20%的循环机械拉伸下分层明显,补片厚度显著增加(P=0.001);动物体内植入2周后,可见补片明显分层,与组织融合较差。结论BM/SIS生物补片层间结构稳定,不易发生分层,补片强度稳定,可以有效防止补片分层造成的疝复发风险。Objective To evaluate the effect of simulated intra-abdominal pressure on the delamination performance of biological mesh and the risk of hernia recurrence after implantation repair in Beagle dog full-layer abdominal wall muscle defect model.Methods Two commercially available biological meshes were selected as samples basement membrane/small intestinal submucosa(BM/SIS)composite mesh and small intestinal submucosa(SIS)mesh.To simulate the continuous force intra-abdominal environment of the biological mesh,the meshes were mechanically stretched for 20,000 cycles(stretching rate±10%and±20%)in a normal saline liquid environment,to study the effect of mechanical loading on the delamination performance.Four Beagle dogs were selected and the whole abdominal wall muscle was removed to construct the full-layer abdominal wall muscle defect model.Different biological meshes(BM/SIS,SIS)were used for repair.All the Beagle dogs were fed for 2 weeks after operation and then killed.The mesh and surrounding tissues were removed,and the delamination of mesh after implantation in animals and hernia recurrence were assessed.Results After 20,000 cycles of mechanical stretching,the BM/SIS composite mesh did not show significant delamination and thickness change.Tissue repair after implantation in Beagle dogs with full-layer abdominal wall muscle defect had good repair effect,and no hernia recurrence was observed.The SIS mesh exhibited space increase and significant thickness change(P=0.007)under±10%cycles of mechanical stretching,and significant and increasing thickness(P=0.001)under±20%cycles of mechanical stretching.After 2 weeks of implantation,the SIS mesh was significantly delaminated and poorly integrated with the tissue.Conclusion The BM/SIS biological mesh has a stable interlayer structure,which is not easy to be delaminated.The strength of the BM/SIS mesh is stable,which can effectively prevent the risk of hernia recurrence caused by the delamination of the mesh.

关 键 词：生物疝修补补片 腹内压力 力学加载 补片分层 疝复发 

分 类 号：R656.2[医药卫生—外科学]