预防实验家兔肉膜和深筋膜植入扩张器移位方法的改进

Improvement in preventing the displacement of tissue expander implanted between the panniculus carnosus and deep fasia in rabbits

目的探讨预防兔肉膜和深筋膜植入扩张器移位的方法。方法普通级实验家兔40只,随机分为两组,即实验组20只和对照组20只。在其一侧背部皮肤肉膜深面自切口潜行分离形成植入腔穴,在腔穴周边,用3-0丝线间断缝合肉膜、深筋膜,植入50 m L肾形硅橡胶软组织扩张器。术后1周,用文刺机在扩张器周围四点做黑色文刺,用来标记扩张器位置。实验组术后2个月开始注水直至达到总量140 m L;对照组术后1周开始注水直至达到总量140 m L。分别观察和记录实验组和对照组扩张器在注水期间是否移位、切口是否裂开、注射壶是否翻转等并发症,以及动物的死亡率。结果实验组中没有兔子发生扩张器移位,对照组存活动物中有4只兔子发生扩张器移位,两组扩张器移位相比较,差异具有统计学意义﹙P<0.05﹚;实验组兔子扩张期切口裂开发生率虽然低于对照组,但两组比较没有统计学意义﹙P>0.05﹚;同时两组扩张器在注水壶翻转率、感染率及动物死亡率方面相比较都无统计学意义﹙P>0.05﹚。结论分离腔隙内固定加上延迟扩张的手术方法可有效预防兔肉膜与深筋膜之间的扩张器移位,实现有效扩张。

Objective To investigate the method to prevent the displacement of tissue expander implanted between the panniculus carnosus and deep fasia in rabbits. Method 40 rabbits were divided into two groups randomly： the experimental group and the control group. Through an incision on the back, a pocket was made by dissecting between the rabbit panniculus carnosus and deep fasia. The panniculus carnosus at the pocket boundary were sutured with the deep fascia inside the pocket by interrupted 3 - 0 sutures. A 50 mL kidney-shaped tissue expander was implanted. The expander was inflated with 10 mL saline after the wound was sutured. 7 days after implantation, black tattoos were made on the skin around the expander to mark the site of expander. Two months after implantation, the expanders in the experimental group were inflated with 10 mL saline weekly to a total of 140 mL. 7 days after implantation the expanders of control group were inflated with 10 mL saline weekly to a total of 140 mL. The reversal of injection pot and death were recorded. Results experimental group. All the expanders were located within incidence of expander displacement, dehiscence of incision, There was no expander displacement in the 19 rabbits of the tattoo area. There was no expander displacement in 11 rabbits of the control group. 4 expanders of the control group moved from the back to belly. The difference between them was statistically significant （ P 〈 0.05 ）. The incidence of dehiscence of incision in the experimental group was not significantly lower than that in the control group （ P 〉 0.05 ）. Meanwhile there was no significant difference in the incidences of reversal of injection pot, infections and deaths （ P 〉 0.05 for all）. Conclusions Sutures between the panniculus carnosus and the deep fascia at the pocket boundary asistcd by delayed inflating can prevent the displacement of tissue expander implanted between the panniculus carnosus and deep fasia in rabbits, thus to obtain effective expansion.