污染伤口清洗后放置聚丙烯网片的可行性研究

目的通过动物实验研究污染伤口被清洗后放置聚丙烯网片能否一期愈合，探讨嵌顿性腹股沟疝肠坏死患者用聚丙烯网片作无张力修补术的可行性。方法30只新西兰兔（简称家兔）左右背部伤口用大肠杆菌液污染后20min再用双氧水、生理盐水及0．5％甲硝唑液清洗。伤口清洗前、后均做细菌培养；左背部伤口放置聚丙烯网片，右背部伤口作为对照组，不放置网片，左右背部伤口均予以缝合。术后60d观察伤口愈合情况和感染率并取标本作病理检查。结果伤口清洗前细菌培养，大肠杆菌污染率100％，清洗后左背部伤口污染率16．0％，右背部污染率12．0％，左右两侧差异无统计学意义。6只家兔在实验中死亡，最终存活的24只家兔中，左背部伤口发生脓肿3例，右背部脓肿1例，感染率分别为12．5％和4．17％，两者比较虽有差异，但无统计学意义。病理报告鼎示：放置网片的左背部组织100％有不同稗度的炎性细胞浸润，未放置网片的右背部组织12．5％有炎性细胞浸润，两者比较差异有统计学意义（P〈0．0001）。结论伤口经过大肠杆菌液污染后机体组织可发生不同程度的炎性反应，放置聚丙烯网片可增加组织的炎性反应，嵌顿性腹股沟疝所致肠坏死患者行疝修补术时应慎用或不用聚丙烯网片。

Feasibility study on implanting polyproplene mesh in a contaminated wound after cleaning:an animal experiment

Objective To explore the feasibility of using polyproplene mesh in tension-free herniorrhaghy for incarcerated inguinal hernia in the presence of intestinal necrosis and see whether one-stage healing was possible in an animal model where polyproplene mesh was implanted in a contaminated wound after cleaning. Methods 30 New Zealand rabbits were artificially wounded and contaminated with E coli on both right and left back sides for 20 rain. Wounds were then cleaned with hydrogen peroxide, salineand0.5%metronidazole. Samples from the wounded area were tested for bacterial culture both before and after cleaning. A polypropylene mesh was implanted on the back of the left side and no mesh was implanted on the right side as a control. Wound healing and infection rates on both sides were counted and samples from the wounds were also taken for pathological evaluation at day 60 of implantation. Results The E coli contamination rate was 100% on both sides before wound cleaning. After wound cleaning, the infection rate was 16.00% on the left side and 12.00% on the control side. No significant difference was observed. Six rabbits died during the period of the experiment. The remaining animals （n=214） survived along with the procedure. Three animals were suppurated on the left side and one on the control side. The infection rate was 12.5 % on the left side and 4.17 % on the control side, though the difference was not statistically significant between both sides. However, the pathological result showed a significant difference in infiltration of inflammatory cells between the left side that was implanted with the mesh and the control side without the mesh （100 % vs. 12.5 %, P 〈 0.05）. Conclusions Inflammatory reaction occurred after the wound was contaminated with E coli. Polyproplene mesh implantation enhanced the inflammatory reaction, and therefore is not recommended, or should be very cautious in cases where patients suffer from strangulated inguinal hernia with intestinal necrosis during herniorrhaphy.