Impact of mesh positioning on foreign body reaction and collagenous ingrowth in a rabbit model of open incisional hernia repair
Impact of mesh positioning on foreign body reaction and collagenous ingrowth in a rabbit model of open incisional hernia repair
复制标题
DOI：
10.1007/s10029-009-0580-4
复制
发表时间：
2010-02-01
期刊：
影响因子：
2.3
通讯作者：
Junge, K.
中科院分区：
文献类型：
--
作者：
Binneboesel, M.;Klink, C. D.;Junge, K.
切口疝仍然是最常见的手术并发症之一。75-80%的疝修补术使用不同的补片技术。本研究的目的是评估的依赖性的网片定位和类型的网片植入异物反应和胶原ingrowth.In 24只雄性灰鼠兔，进行了切口疝修补补片加固无论是sublay（n = 12）或onlay技术（n = 12）。在每组中，研究了两种不同类型的补片假体：聚丙烯（PP，Prolene（A（R）和聚丙烯-聚卡普隆25复合材料（PP-PG，UltraPro（A（R）。在术后第60天，通过测量异物肉芽肿的内部细胞浸润和外部纤维囊的直径，并通过验证I/III型胶原蛋白比率，表征炎症和结缔组织形成。此外，分析基质金属蛋白酶-2（MMP-2）的表达。显微镜下观察补片/宿主组织界面显示典型的异物肉芽肿形成。与PP-PG补片相比，PP补片中代表炎性细胞浸润量的异物肉芽肿内部直径显著增加，两种补片均在亚铺组中（PP 13.1 +/- A 1.21 μ m vs. PP-PG 11.7 +/- A 0.34 μ m; P = 0.026）和覆盖组（PP 13.1 +/- A 1.24 μ m vs. PP-PG 11.2 +/- A 0.55 μ m; P = 0.009）。与覆盖位置的PP补片（27.9 +/- A 0.73 μ m）相比，研究覆盖位置的PP补片（29.5 +/- A 1.12 μ m）时，作为肉芽肿外环的纤维囊直径显著增加（P = 0.026）。研究以I/III型胶原蛋白比率表示的牙周膜胶原蛋白沉积的质量，与高嵌组相比，亚嵌组显示出显著升高的值（PP亚层3.1 +/- A 0.18 vs. PP高嵌体2.4 +/- A 0.41; P = 0.004）（PP-PG亚层3.5 +/- A 0.34 vs. PP-PG高嵌体2.6 +/- A 0.13; P = 0.002）。MMP-2表达分析显示无显著性差异。补片加固在sublay技术中的有益结果可能是由于术后结缔组织形成的上级质量。无论位置如何，在重量轻、大、多孔的补片材料中均有利于补片结合，表现为异物肉芽肿的炎性部分减少。
Incisional hernia remains as one of the most common surgical complications. Different mesh techniques are used in 75-80% of hernia repair. The aim of this study was to evaluate the dependence of mesh positioning and the type of mesh implanted on foreign body reaction and collagenous ingrowth.In 24 male Chinchilla rabbits, an incisional hernia repair was performed with mesh reinforcement either by sublay (n = 12) or by onlay technique (n = 12). In each group, two different types of mesh prosthesis were investigated: polypropylene (PP, Prolene(A (R))) and polypropylene-polyglecaprone 25 composite (PP-PG, UltraPro(A (R))). On postoperative day 60, the inflammatory and connective tissue formation was characterised by measuring the diameter of inner cellular infiltrate and outer fibrous capsule of the foreign body granuloma, and by verifying the collagen type I/III ratio. Furthermore, the expression of matrix metalloproteinase-2 (MMP-2) was analysed.Microscopic investigation of the mesh/host-tissue interface showed typical formation of foreign body granuloma. The diameters of the inner part of the foreign body granuloma representing the amount of inflammatory cell infiltrate were significantly increased in the PP mesh compared to the PP-PG mesh, both in the sublay group (PP 13.1 +/- A 1.21 mu m vs. PP-PG 11.7 +/- A 0.34 mu m; P = 0.026) and in the onlay group (PP 13.1 +/- A 1.24 mu m vs. PP-PG 11.2 +/- A 0.55 mu m; P = 0.009). The diameter of the fibrous capsule as the outer ring of the granuloma was significantly increased when investigating the PP mesh in sublay position (29.5 +/- A 1.12 mu m) compared to the PP mesh in onlay position (27.9 +/- A 0.73 mu m) (P = 0.026). Investigating the quality of perifilamentary collagen deposition expressed as collagen type I/III ratio, the sublay group showed significantly elevated values compared to the onlay group (PP sublay 3.1 +/- A 0.18 vs. PP onlay 2.4 +/- A 0.41; P = 0.004) (PP-PG sublay 3.5 +/- A 0.34 vs. PP-PG onlay 2.6 +/- A 0.13; P = 0.002). The analysis of MMP-2 expression revealed no significant differences.The beneficial results of mesh reinforcement in the sublay technique might be due to a superior quality of postoperative connective tissue formation. Mesh incorporation, irrespective of positioning, is favourable in low-weight, large, porous mesh material represented by a reduced inflammatory part of the foreign body granuloma.