自体腹膜覆盖聚丙烯补片抗粘连作用的实验研究

Prevention of adhesion formation with use of polypropylene mesh that inserted in peritoneal cavity in rats

目的研究在大鼠腹腔内植入聚丙烯(polypropylene PP)补片并以补片旁腹膜覆盖后能否减少聚丙烯补片引起的腹腔粘连。方法选用SD大鼠120只,分为裸露组(A组)、转移组(B组)、翻转组(C组)及游离组(D组),将聚丙烯补片植入大鼠腹腔,以A组作为对照,B、C、D组采用不同的腹膜覆盖的方法,在术后3、7、28 d分别处死大鼠,进行大鼠腹腔内粘连程度检测、组织学检查及扫描电镜检查以了解补片表面的粘连情况。结果术后3 d,对照组A组的聚丙烯补片表面粘连较实验组B、C、D组明显(P<0.05);术后7 d及28 d,A组和D组聚丙烯补片表面粘连明显较B、C组明显(P<0.05)。术后7 d各组补片表面的粘连较3 d时明显,术后28 d时粘连与7 d时相似。补片表面没有粘连的区域术后7 d可见有腹膜覆盖。结论转移及翻转的腹膜能在聚丙烯表面存活并能减少其表面的粘连,而游离的腹膜坏死后并不能减少聚丙烯补片表面的粘连。

Objective To study whether peritoneum could reduce adhesions to polypropylene mesh that inserted in peritoneal cavity in rats. Methods In 120 male Sprague Dawley rats, polypropylene mesh was inserted in peritoneal cavity with adjacent peritoneum covered in different ways. Group A was blank contrast, polypropylene mesh was inserted into peritoneal cavity and fixed on four angles using 5-0 absorbable threads. In group B, polypropylene mesh was inserted into peritoneal cavity and covered with transferred adjacent peritoneum, then was fixed on four angles. In group C, polypropylene mesh was inserted into peritoneal cavity and covered with upturned adjacent peritoneum, then was fixed on four angles. In group D, polypropylene mesh was inserted into peritoneal cavity and covered with disconnected peritoneum, then was fixed on four angles. Rats were sacrificed at various time intervals. Adhesion formation at the surface of polypropylene mesh was evaluated. Samples underwent both light and scanning electron microscopy. Results On the third day after operation, adhesions to polypropylene mesh in group A were much severer than that in group B,C,D（P〈0.05）. On the seventh and the twenty-eighth day, adhesions were much severer in group A and D （P〈0.05）. The areas, where no adhesion was found, were covered with a converging mesothelial cell layer on day 7. Conclusions Peritoneum transferred or upturned from adjacent areas （group B and C） can reduce adhesions onto polypropylene mesh, but disconnected peritoneum （group D） has no effect on reducing adhesions due to inflammatory reaction caused by the necrosis of peritoneum.