载有纳米银新型复合补片在污染条件下大鼠腹壁缺损修补中的运用

Contaminated abdominal wall repair with nano-silver composite patch in rats

目的观察载有纳米银新型复合补片在污染条件下对大鼠腹壁缺损修补的应用效果,对其耐受感染和防粘连效果进行评价,进而探讨新型补片在感染条件下腹壁缺损一期修复中应用的可行性。方法成年雄性SD大鼠60只,体重200~280 g,随机分为普通聚丙烯补片组（A组）和新型纳米银复合补片组（B组）,制备污染条件下大鼠腹壁缺损模型（缺损面积2 cm×2 cm）,分别使用以上两种补片完成一期修复,术后对比观察两组大鼠一般情况及伤口愈合情况,术后30 d处死大鼠观察腹腔脏器粘连情况,同时切取补片及其周围组织进行病理学观察。结果术后30 d内共4只大鼠死亡,其中A组3只,B组1只,死亡原因与补片修补无关。切口愈合情况B组优于A组（P〈0.05）,术后30 d二组均见腹腔脏器与补片粘连,主要为肠管、网膜,B组轻于A组,按照修正的Katada粘连评分方法,差异有统计学意义（P〈0.05）;组织学观察,术后30 d,光镜下聚丙烯补片组依然有大量炎细胞浸润,可见毛细血管生长,成纤维细胞开始大量增生,胶原分泌增多,局部肉芽组织形成。新型纳米银复合补片组创面可见少量炎细胞浸润,成纤维细胞增生,胶原纤维和毛细血管大量增多,肉芽组织结构致密,成熟度高。结论新型纳米银复合补片在污染条件下腹壁缺损的一期修复中,具有更好的耐受感染、抗腹腔粘连特性,具有较好的临床应用前景,但其远期效果及生物安全性尚需进一步研究和评价。

Objective To observe the effect of nano-silver composite patch in the repair of abdominal wall defect in rats under contaminated environment,and to investigate the abilities of infection tolerance and anti-adhesion so as to investigate the feasibility of the application of the new type of patch in the repair of abdominal wall defect with infection. Methods Sixty adult male SD rats（ weighing 200 to280 g） were randomly divided into 2 groups（ n = 30） ： ordinary polypropylene patch group（ group A） and new type of nano-silver composite patch group（ group B）. The abdominal wall defect models（ 2 cm × 2 cm in size） were established in the rats,and the defects were repaired with 2 kinds of patches,respectively,according to grouping method. The animals were sacrificed at 30 days after operation for morphologic and histological observations. Results Four rats died within 30 days after the operation（ 3 in group A,1 in group B）,no hernia occurred in 2 groups. Group B was better than group A in wound healing（ P 0. 05）.Adhesion was observed in both group A and group B,while nano-silver composite patch presented less visceral adhesion at 30 days postoperatively,and the difference was significant according to the modified Katada adhesion score（ P 0. 05）. The histological results showed that inflammatory cell infiltration,fibroblasts,secreted collagen,granulation tissue formation were observed in ordinary polypropylene patch group at 30 days,compared with decreased inflammatory cell infiltration,increased fibroblasts,more mature granulation tissue,more collagen deposited in nano-silver composite patch group. Conclusion Abdominal wall defect repaired primarily with nano-silver composite patch in contaminated field,presents better wound healing and less visceral adhesion in the abdominal cavity,compared with polypropylene mesh. And the former has better clinical application prospects,but its long-term effect and biological safety need to be further studied and evaluated.