不同材质补片固定大鼠膈肌后的炎症反应、粘连及补片皱缩情况对比研究

Comparative study of inflammatory reaction, adhesion and mesh shrinkage following diaphragmatic fixation with different types of meshes in rats

背景与目的:食管裂孔疝是外科常见病症,临床上多采用补片以无张力修补的方式进行治疗。食管裂孔疝的补片修补中补片的选择及其应用效果方面的实验数据仍相对缺乏。因此,本研究通过在大鼠食道裂孔处膈肌组织上分别固定聚丙烯补片和复合补片,比较两种材质补片对周围组织的影响,以及自身皱缩情况,为临床食管裂孔疝补片的选择提供参考。方法:雄性SD大鼠在分离胃部与肝脏相连接组织显露胃食道裂孔后,分别用单丝缝线将轻量聚丙烯补片(聚丙烯补片组)或复合补片(复合补片组)固定于食道裂孔处膈肌组织,或不进行补片固定(假手术组)。分别在术后7、15、30 d时记录每组每只大鼠的体质量和饮食量。观察30 d后处死大鼠,分析补片皱缩程度、粘连强度以及膈肌组织的病理学变化。结果:各组大鼠手术前后的体质量及每天进食量均无明显的变化(均P>0.05)。复合补片组膈肌组织与补片的粘连范围及粘连程度分值均明显低于聚丙烯补片组(均P<0.05);两组补片均出现皱缩,但复合补片组术后补片面积明显大于聚丙烯补片组,皱缩率明显低于聚丙烯补片组(均P<0.05);与假手术组比较,聚丙烯补片组和复合补片组膈肌组织出现局部肌纤维萎缩,同时观察到其局部淋巴细胞和巨噬细胞等炎症细胞的浸润反应;复合补片组的膈肌组织纤维包裹层显得更厚,但其粘连菲薄,很容易和腹腔脏器粘连相分离。与假手术组比较,聚丙烯补片组和复合补片组膈肌组织中巨噬细胞表面标志物(CD68)及T淋巴细胞标志物(CD3)的阳性表达明显上升,但复合补片组膈肌组织中CD68及CD3的阳性细胞表达比例明显低于聚丙烯补片组(均P<0.05)。结论:复合补片在粘连、炎症反应,以及自身皱缩方面均优于聚丙烯补片,具有较好的生物相容性和稳定性,推荐临床使用。

Background and Aims:Esophageal hiatal hernia is a common surgical condition,which is usually treated by tension-free mesh repair in clinical practice.However,there is still a relative lack of experimental data on the selection and application effectiveness of different types of meshes in esophageal hiatal hernia repair.Therefore,this study was conducted to compare the effects of fixing polypropylene mesh and composite mesh on the surrounding tissues and their own shrinkage at the diaphragmatic defect in rats,in order to provide reference for the selection of esophageal hiatal hernia meshes in clinical practice.Methods:Male Sprague-Dawley rats underwent exposure of the gastroesophageal hiatus by separating the gastroesophageal junction from the liver.A lightweight polypropylene mesh(polypropylene mesh group)or a composite mesh(composite mesh group)was respectively fixed to the diaphragmatic tissue at the hiatal hernia site using monofilament sutures,or no mesh fixation was performed(sham surgery group).Body weight and food intake of each rat in each group were recorded at postoperative day 7,15,and 30.Rats were sacrificed after 30 d,and the degree of mesh shrinkage,adhesion strength,and histopathological changes in the diaphragmatic tissue were analyzed.Results:There were no significant changes in body weight and daily food intake before and after surgery in all groups(all P>0.05).The extent and severity of adhesion between the diaphragmatic tissue and the mesh were significantly lower in the composite mesh group than those in the polypropylene mesh group(both P<0.05).Both mesh types showed mesh shrinkage,but the postoperative mesh area was significantly larger and the shrinkage rate was significantly lower in the composite mesh group than those in the polypropylene mesh group(both P<0.05).Compared to the sham surgery group,local muscle fiber atrophy,as well as infiltration of inflammatory cells such as lymphocytes and macrophages,were observed in the diaphragmatic tissue of both the polypropylene mesh group and the composite mesh group.The fibrous encapsulation layer of the diaphragmatic tissue in the composite mesh group appeared thicker,but the adhesion was thinner,easily separated from the intra-abdominal organs.Compared to the sham surgery group,the expression of surface markers for macrophages(CD68)and T lymphocytes(CD3)in the diaphragmatic tissue was significantly increased in both the polypropylene mesh group and the composite mesh group,but the proportion of positive cells expressing CD68 and CD3 was significantly lower in the composite mesh group compared to the polypropylene mesh group(both P<0.05).Conclusion:The composite mesh is superior to polypropylene mesh in terms of adhesion,inflammatory response,and mesh shrinkage,and it has good biocompatibility and stability,therefore,it is recommended for clinical use.