聚丙烯纤维基/硅树脂复合腹壁疝修复补片移出物的研究

Research on the Explant of Composite Polypropylene Fibers Substrate/Silicone Ventral Hernia Mesh

该文以一种腹壁疝修复补片移出物植入前后的理化性能变化,结合组织病理学分析,探究补片与人体间的相互作用与疝复发的可能原因。研究表明,人体组织大部分长在聚丙烯纤维面,硅树脂面引流孔处有组织长入,产生部分粘连。长入人体组织的补片皱缩率达49.89%。当人体组织去除后,通过SEM观察可知,聚丙烯纤维表面出现较多不规则横向裂缝,硅树脂面表面完整。DSC和TGA测试结果显示聚丙烯纤维热稳定性能降低。ATR-FTIR测试结果中没有出现代表聚丙烯纤维被氧化的羰基峰,硅树脂化学稳定性较好。组织病理学分析显示聚丙烯纤维周围有部分炎性细胞存在,但整体炎症反应不大。综上所述,聚丙烯纤维降解、硅树脂面引流孔处的粘连,补片结构的明显皱缩,都可能是引起疝复发的主要原因。该文还为补片结构的设计提供了新思路,即要适当增大纤维间孔隙和减少引流孔分布和其孔径。

In this study,an explanted ventral hernia mesh was set to analyze the interaction between mesh and tissue in human body and the reasons of hernia recurrence via comparing the changes of physicochemical properties,as well as histopathology analyzing before and after implantation.Our research suggested that most of the human ventral tissue grew on the surface of polypropylene(P P)fibers side.As for silicone side,tissue only grew into the holes of mesh and formed partial adhesions.The mesh-tissue interaction made the mesh shrank rate up to 49.8 9%.After the removal of human tissue,further SEM characterization showed that there were many irregular and horizontalcracks on the surface of explanted PP fibers,but the silicone side maintained pristine structure.Moreover,the results of DSC and TGA showed that the thermal stability of PP fibers reduced.The carbonyl peaks representing the oxidation of the polypropylene fibers were not shown in the ATR-FTIR results,which meant that the chemical stability of silicone was good.Histopathological analysis showed that some inflammatory cells appeared around the polypropylene fibers,but the overall inflammation was not serious.The results indicated the main reasons of the hernia recurrence,including the degradation of PP fibers,the adhesions of silicone side holes,and the severe mesh shrink.Meanwhile,the results suggest that as for the meshes,there should be less holes and smaller hole aperture,as well as bigger fibers spacing.