Gynemesh聚丙烯补片在盆底重建中的应用效果

Pelvic floor reconstruction using Gynemesh

背景:Gynemesh聚丙烯补片由单丝聚丙烯编织而成,经过加工后能形成定型的平坦形状,具有较强的抗张力强度、较小的异物反应及良好的生物相容性。目的:分析Gynemesh聚丙烯补片在盆底重建中的应用效果。方法:采用化学液相还原方法制备Gynemesh聚丙烯补片,进行厚度、断裂伸长率、抗拉强度及弹性模量检测及组织学观察。在8只雌性新西兰大白兔阴道放置气囊,模拟盆底功能障碍模型,随机分为2组,实验组采用Gynemesh聚丙烯补片进行盆底重建,对照组进行阴道前后壁修复及全子宫切除。术后30 d,对比两组PFDI-20、PFIQ-7评分。结果与结论:(1)Gynemesh聚丙烯补片厚度为(0.37±0.14)mm、断裂伸长率为(25.35±2.68)%、抗拉强度为(7.69±1.17)MPa、弹性模量为(0.007±0.008)GPa;光镜下观察显示,Gynemesh聚丙烯补片有大量淡红色胶原纤维且排列整齐,无蓝色染核物、无细胞残留;扫描电镜观察显示,Gynemesh聚丙烯补片上未见细胞残留且纤维保存完好,排列紧密;(2)实验组补片未出现侵蚀反应,术后30 d取出时补片完整,未在体内发生降解。实验组术后并发症发生率低于对照组(P<0.05);(3)结果表明:Gynemesh聚丙烯补片具备良好的生物力学性能,可促进盆底功能恢复。

BACKGROUND：Gynemesh is a polypropylene fabricwovenby monofilament polypropyleneshaped into a flat form, with a strong tensile strength, smal foreign body reaction and good biocompatibility. OBJECTIVE：To investigate the effect of Gynemesh on pelvic floor reconstruction. METHODS：Gynemesh was prepared by the chemical reduction method in the liquid-phase, andobserved histologicaly.Then its thickness, elongation at break, tensile strength,andelasticity modulus were detected. Eight female New Zealand rabbits were used to make pelvic floor dysfunction models by a vaginal baloon, and randomly assigned into experimental group （pelvic floor reconstruction using Gynemesh） or control group （vaginal wal repair and hysterectomy）, respectively. Thirty days post surgery, the Pelvic Floor Impact Questionnaire （PFIQ-7） and Pelvic Floor Distress Inventory （PFDI-20） were detected and compared between two groups. RESULTS AND CONCLUSION：The Gynemesh had a thickness of （0.37±0.14） mm, an elongation at break of （25.35±2.68）%, a tensile strength of （7.69±1.17） MPa, and an elastic modulus of （0.007±0.008） GPa. Under the light microscope, a large amount of pink colagen fibers arrangedneatlyon the Gynemesh, but no blue nuclear material and residual celsexisted. Under the scanning electron microscope, the fibers were tightly packed with no residual cels on the Gynemesh. At 30 days after surgery, the Gynemesh was not degraded and no erosion reaction occurred in the experimental group. Moreover, the experimental group had a lower incidence of complications compared with the control group （P〈 0.05）. These findings indicate that the Gynemesh hasgood biological performance and it is an ideal material for pelvic floor reconstruction.