基于腹膜组织病理探讨腹外疝完全腹膜外腹膜前间隙补片修补术对腹膜的影响

Effect of total extraperitoneal herniorrhaphy via preperitoneal space approach on peritoneum based on peritoneal histopathology of external abdominal hernia

目的观察大鼠切口疝完全腹膜外腹膜前间隙补片修补术后腹膜的病理改变情况,并探讨在该手术中对腹膜前间隙的广泛游离以及补片的植入是否会造成腹膜的缺血坏死以及影响其功能。方法选取80只SD大鼠,采用简单随机方法随机分为空白对照组(n=8)、疝模型对照组(n=8)、补片植入空白对照组和疝模型补片修补组,后2组分别于植入补片后第1、4、8、12周时随机抽取8只大鼠。空白对照组取正常腹膜及周围组织,疝模型对照组、补片植入空白对照组和疝模型补片修补组取切口旁腹膜组织,采用苏木精-伊红染色进行腹膜组织病理学检查并比较各组腹膜组织的炎细胞浸润程度和纤维化增生程度的变化情况。结果(1)各组间腹膜组织的炎细胞浸润程度比较:补片植入空白对照组术后第1和4周时较空白对照组加重(P<0.001、P=0.005),补片植入空白对照组术后第8周时较术后第1周时减轻(P=0.021),疝模型对照组与空白对照组比较差异无统计学意义(P=0.102),疝模型补片修补组术后第1周时较疝模型对照组加重明显(P=0.014),疝模型补片修补组术后第8和12周时较术后第1周减轻(P=0.040、P=0.040),相同时间点时补片植入空白对照组与疝模型补片修补组间比较差异均无统计学意义(P>0.05)。(2)各组间腹膜组织的纤维化增生程度比较:补片植入空白对照组术后第1、4、12周时较空白对照组明显加重(P<0.001、P=0.003、P=0.043),补片植入空白对照组术后第8周时较术后第1周时减轻(P=0.017),疝模型对照组较空白对照组明显加重(P=0.012),疝模型补片修补组术后不同时间点时与疝模型对照组比较差异未见有统计学意义(P>0.05),疝模型补片修补组术后不同时间点的变化差异也不明显(P>0.05),相同时间点时补片植入空白对照组与疝模型补片修补组间比较差异均无统计学意义(P>0.05)。结论疝本身不会刺激腹膜组织发生炎细胞浸润和纤维化增生,然而在行完全腹膜外腹膜前间隙补片修补过程中,广泛的腹膜前间隙游离以及补片的植入操作会造成腹膜的损伤并影响其功能,但通过机体自身的修复,由腹膜损伤及它引起的功能影响在术后第8周时基本可完全恢复至正常。

Objective To observe the pathological changes of the peritoneum before and after the total extraperitoneal herniorrhaphy via preperitoneal space approach for incisional hernia in rats,and to explore the effects on the ischemia and necrosis of the peritoneum and its function after the extensive dissociation of the preperitoneal space and the implantation of the patch.Methods A total of 80 SD rats were randomly divided into normal control group(n=8),hernia model control group(n=8),patch implantation blank control group,and hernia model patch repair group.Eight rats were randomly selected at week 1,4,8,and 12 after patch implantation from the patch implantation blank control group and hernia model patch repair group.The normal peritoneum and surrounding tissues were taken from the normal control group,and the peritoneal tissues near the incision were taken from the hernia model control group,patch implantation blank control group,and the hernia model patch repair group.The hematoxylin-eosin staining was performed to observe the pathological changes of the peritoneum.The degrees of inflammatory cell infiltration and fiber hyperplasia among the different groups were compared.Results①Comparison of the degree of inflammatory cell infiltration in the peritoneal tissue,which in the patch implantation blank control group at week 1 and 4 after patch implantation was more severe than the normal control group(P<0.001,P=0.005)respectively,which at week 8 after patch implantation was alleviated(P=0.021)as compared to the 1st week after patch implantation in the patch implantation blank control group,which had no statistic difference between the patch implantation blank control group and normal control group(P=0.102),which at the 1st week after patch implantation was more severe than hernia model control group(P=0.014),which was alleviated at week 8 and 12 after patch implantation as compared to the 1st week after patch implantation in the hernia model patch repair group(P=0.040,P=0.040),which had no statistic differences between the patch implantation blank control group and the hernia model patch repair group at same time point after patch implantation(P>0.05).②Comparison of the degree of fiber hyperplasia in the peritoneal tissue,which at week 1,4,and 12 after patch implantation was more severe(P<0.001,P=0.003,P<0.001,respectively)in the patch implantation blank control group as compared with the normal control group;which was alleviated at week 8 after patch implantation as compared to the 1st week after patch implantation in the hernia model patch repair group(P=0.017);which was more severe in the hernia model control group as compared with the normal control group(P=0.012);which had no statistical differences between the hernia model control group and the hernia model patch repair group at different time point(P>0.05);which had no obvious change between-time point in the hernia model patch repair group(P>0.05);which had no statistic differences between the patch implantation blank control group and the hernia model patch repair group at same time point after patch implantation(P>0.05).Conclusions Based on the experimental results of this study,hernia itself will not stimulate inflammatory cell infiltration and fiber hyperplasia of peritoneal tissue.However,during the process of total extraperitoneal herniorrhaphy via preperitoneal space approach,extensive peritoneal space dissociation and patch implantation will cause peritoneal injury and affect its function.But through the body itself repair,the function caused by peritoneal injury can be fully restored to normal status on the 8th week after patch implantation.