NaOH消蚀法制备脱细胞真皮基质修补腹壁疝

Acellular dermal matrix prepared by NaOH-maceration for ventral hernia repair

背景:与其他疝修补材料相比,脱细胞真皮基质具有易血管化、抗感染、从而可用替代传统补片用于感染腹壁缺损重建等特点。目的:观察NaOH消蚀法制备的脱细胞真皮基质作为修补材料应用于腹疝的应用价值。方法:以全厚猪皮制成脱细胞真皮基质,45只SD雄性大鼠制备腹壁疝模型,随机数字表法分为腹壁疝组:直接缝合皮肤,Marlex网组和脱细胞真皮基质组:分别应用大小为3.5cm×4.0cm的Marlex网和脱细胞真皮基质缝合皮肤;观察修复后1周时有无腹壁疝发生,脱细胞真皮基质组修复后1,2,3,5,10周分别取材,其中每周各组取4只用于苏木精-伊红染色,光镜观察。修复后第5周Marlex网组和脱细胞真皮基质组各取6只用于抗张力试验。结果与结论:术后1周脱细胞真皮基质组与Marlex网组腹壁疝发生率均显著低于腹壁疝组(P<0.001)。脱细胞真皮基质的胶原纤维无明显变化,即有少量成纤维细胞植入,术后2周可见新生血管,术后5周脱细胞真皮基质内部血管密度基本稳定。将单独脱细胞真皮基质片与Marlex网行抗张力试验,Marlex网的抗张力显著高于脱细胞真皮基质(P<0.001)。但植入体内5周后,脱细胞真皮基质筋膜组织的抗张力高于Marlex-筋膜组织(P<0.05)。提示复合消蚀制备的脱细胞真皮基质可以作为良好的疝修补材料。

BACKGROUND：The use of an acellular dermal matrix（ADM） may represent a new alternative to prosthetic mesh products.OBJECTIVE：To study the value of porcine ADM made by NaOH-maceration as ventral hernia-repairing material.METHODS：ADM was made from the full thick skin of the back of swines by NaOH-maceration.Forty-five male SD rats were randomly divided into three groups including ventral hernia group（n=7）,ADM group（the ventral hernia repaired by 3.5 cm× 4.0 cm ADM,n=28） and Marlex mesh group（the ventral hernia repaired by 3.5 cm×4.0 cm Marlex mesh,n=10）.The occurrence of ventral hernia was observed postoperatively 1 week.To evaluate ADM histology,4 rats in ADM group were sacrificed at 1,2,3,5 and 10 weeks after surgery respectively;6 rats were respectively selected from the Marlex group and ADM group for the experiment of tension resistance at 5 weeks after surgery.RESULTS AND CONCLUSION：The occurrence of ventral hernia in ADM group and Marlex mesh group was significantly lower than that of ventral hernia group 1 week after surgery（P 0.001）,but there was no difference between ADM group and Marlex mesh group（P 0.05）.The collagen of ADM did not change much after implantation.ADMs became infiltrated with little fibroblasts by 1 week after surgery.New wessels in ADMs were found by 2 weeks after surgery.The vessel density of ADMs kept stable by 5 weeks after surgery.The Marlex had a significantly higher breaking strength than that of the ADM（P 0.001）.But 5 weeks after surgery,the tension resistance of ADM-fascial interface was higher than that of the Marlex-fascial interface（P 0.05）.ADM prepared by the maceration of NaOH can be used as the material repairing ventral hernia.