脱细胞基质补片阴道黏膜埋植的动物在体研究

目的:在动物模型体内研究异种(猪皮、牛心包)来源的脱细胞基质补片在盆底修复中的作用。方法:选取北京农业大学培育的中国小型实验猪13只,分成3组,将小型猪阴道黏膜前后壁全层分离,并将异种来源的脱细胞基质补片(B型牛心包来源和P型猪皮来源)和人工合成网片埋植在小型猪阴道黏膜内,制成3种材料的动物在体模型。B型、P型脱细胞基质材料(ATM)组分别在术后2、4、6、8、12周,人工合成网片(美国强生公司)组在术后2、4、8周,各1只取材,取材后进行ET-VG染色,动态观察补片在动物体内分解代谢、与周围基质相互转化的情况以及补片周围的黏膜反应等。结果:大体和组织学观察示B、P两型脱细胞基质补片在动物体内都存在降解,且大致规律相同(移植12周后基本代谢)。与ATM材料相比,人工合成网片的反应较为均一,与宿主组织较好的融合,进入网片的网眼之间,周围可见新生胶原纤维、成纤维细胞、血管和弹力纤维。结论:异种脱细胞基质补片在动物阴道黏膜埋植中存在明显降解可能是造成临床复发率高的原因之一。人工合成聚丙烯网片在动物体内无代谢,从生物力学强度方面考虑,作为盆底修复手术的材料更具优势。需调整异种脱细胞基质补片的降解率,以适应盆底修复手术要求。     

脂肪源性干细胞对大鼠阴道黏膜下生物补片移植物的影响

目的探讨脂肪源性干细胞(ADSCs)对大鼠阴道黏膜下生物补片生物相容性的影响。方法 2010年4月至2011年2月在广州医学院第一附属医院,获取大鼠腹股沟处脂肪组织分离培养ADSCs,选择第3代细胞与脱细胞猪心包膜(APP)、脱细胞牛心包膜(ABP)两种生物补片构建新型组织工程补片,选取体外培养1、7d的新型组织工程补片进行扫描电镜。根据大鼠阴道黏膜下植入生物补片的不同类型,将20只去势SD雌性大鼠随机分为5组:APP组,ABP组,APP+ADSCs组,ABP+ADSCs组,对照组。术后30d植入部位取材,HE染色观察组织的炎症反应程度,巨噬细胞及异物巨细胞计数。结果 ADSCs可以在两种生物补片上黏附及生长。与ABP组比较,APP组局部的炎症反应及异物反应较重,补片结构破坏明显。加载ADSCs的两种生物补片植入局部组织的炎症反应及异物反应明显低于未加载ADSCs的生物补片。结论 ABP较APP具有更好的生物相容性。ADSCs可以调节生物补片植入部位的炎症反应及异物反应,可能对生物补片的降解有缓解作用。     

生物补片在女性盆底重建术中的应用进展

简述了生物材料的分类及目前常用的生物补片种类,并以猪小肠黏膜下层(small intestinal submucosa,SIS)为例,介绍了生物补片的成分及各自在组织修补过程中的作用机制。分析了同层数不同种类间或同种类不同层数间生物补片的力学强度的差异,得出目前应用较多的生物补片为4层的SIS,其力学强度既可达到支撑盆底组织早期修补的作用,又能同时兼顾阴道壁柔软度且富于弹性的特点。基于生物补片的力学性能及可降解特性,不是所有盆底重建部位都能用生物补片来进行修补,如在持续抗拉强度占主导地位部位的重建,如穹窿骶骨固定和重度膀胱膨出修补,合成网片可能会提供一个更好的解剖效果。而在治疗压力性尿失禁的手术中,两者的成功率相当。对于性生活活跃的患者,尤其是年轻女性,在恢复阴道壁的正常解剖结构及保留其柔软且富于弹性的功能方面,生物补片具有独特的优势。作为一种新兴材料,生物补片在盆底重建术中的应用尚处于探索阶段,但随着盆疷器官脱垂患者的年轻化,生物补片仍具有潜在的发展空间。     

脱细胞生物组织补片在盆底重建手术中的应用

目的初步探讨脱细胞生物组织补片在盆腔器官膨出患者盆底重建手术中的应用情况。方法选择北京大学人民医院妇科2006年5月至12月期间接受盆底修补和重建手术并应用脱细胞生物补片的盆腔器官膨出患者20例,其中子宫脱垂19例,子宫切除术后阴道穹隆脱垂Ⅱ度1例;合并存在膀胱膨出20例、直肠膨出17例。20例患者中17例同时行阴道前后壁修补术,3例行阴道前壁修补术;阴道前壁置入补片15例,阴道后壁置入补片2例,阴道前壁和后壁同时置入补片3例。结果20例患者总手术时间平均为113．1min（70～180min）,其中放置补片的时间平均为10min。术中出血平均为175ml（50～300ml）。术后恢复良好,平均随访9．3个月（6～12个月）,未发现补片侵蚀阴道黏膜情况,无感染发生。随访期间4例（20％）患者出现盆腔器官膨出复发,3例为膀胱膨出Ⅰ度,复发时间均为6个月复查时,其中2例随访12个月时仍为膀胱膨出Ⅰ度,另1例随访8个月时也为膀胱膨出Ⅰ度,未见加重;1例为膀胱膨出Ⅱ度,复发时间为6个月复查时;所有复发患者均无临床症状。结论脱细胞生物组织补片用于盆底重建手术,方法简单,操作容易,未见补片侵蚀发生,其长期效果有待进一步观察。     

围绝经期盆底松弛患者子宫韧带组织形态学及胶原含量的变化

目的 探讨围绝经期盆底松弛患者子宫主、骶韧带的组织形态学变化及胶原含量与盆底松弛发生的关系.方法 选择因妇科疾病需行子宫全切除术的患者28例,其中围绝经期盆底松弛者14例(盆底松弛组),无盆底松弛者14例(对照组).每例取主、骶韧带组织,经病理切片,行Masson染色,观察其组织形态学特征,并用免疫组化法检测其I、Ⅲ型胶原含量.结果 (1)子宫主、骶韧带Masson染色结果显示,胶原纤维呈蓝色,盆底松弛组与对照组比较,胶原纤维染色较浅,染色不均匀,胶原纤维排列较为稀疏,但灶性排列紧密,比较细碎,胶原纤维明显萎缩.(2)免疫组化分析可见,胶原纤维阳性区域呈浅棕色至深褐色,盆底松弛组主韧带I、Ⅲ型胶原阳性单位分别为13.8±2.1、9-6 ±2.4,对照组为27.4 ±3.5、17.7±4.0,两组分别比较,差异均有统计学意义(P<0.01);盆底松弛组骶韧带I、Ⅲ型胶原阳性单位分别为15.8 ±2.5、10.3 ±3.6,对照组为29.5 ±4.4、19.3 ±4.6,两组分别比较,差异也均有统计学意义(P<0.01).结论 围绝经期盆底松弛患者盆底组织中I、Ⅲ型胶原含量减少,胶原萎缩变性可能是盆底松弛的病变基础.     

猪小肠黏膜下层生物补片治疗盆腔器官脱垂的手术疗效分析

目的探讨应用猪小肠黏膜下层生物补片(SIS)治疗盆腔器官脱垂(POP)的临床效果及并发症。方法回顾性分析2012年3月-2013年12月在北京大人民医院应用SIS行盆底重建手术的44例POP-Q≥Ⅱ期患者的临床资料。比较手术前后POP-Q各指示点位置及生活质量相关问卷(PFIQ-7、PFDI-20和PISQ-12)评分,分析术后患者的主客观复发率及下尿路症状。结果 44例患者随访时间为(2.4±0.7)年。术后患者主观复发率为6.8%(3/44),远低于客观复发率(36.4%,16/44)。术后未发生补片暴露。1例因尿潴留行补片缝线松解;1例阴道后壁补片植入部位感染,伴阴道疼痛,外用雌激素软膏后症状缓解;1例术后阴道前壁复发性脱垂Ⅲ期行Avaulta补片植入手术。患者PDFI-20评分由术前(66.25±28.35)分降为术后(17.03±21.00)分,PFIQ-7评分由术前(61.15±49.23)分降为术后(1.41±23.20)分,PISQ-12评分由术前(15.50±2.61)分降为术后(13.20±4.25)分。手术前后比较,除性生活质量评分外,差异均有统计学意义(P0.05)。结论应用SIS对POP患者行盆底重建手术后,患者生活质量明显提高,性生活质量无明显变化。患者主观满意度高,并发症少。基于较高的阴道前壁脱垂复发率,需要特别注意阴道前壁的修补,远期效果尚待随访观察。     

原位与体内构建小鼠组织工程阴道的实验研究

目的:比较原位组织构建与体内构建两种方式在小鼠体内进行阴道重建的效果.方法:切除昆明小鼠阴道后采用酶消化法获得阴道上皮细胞.A组(12只)植入猪脱细胞真皮基质(PADM)行原位组织构建;B组(12只)植入自体阴道上皮细胞与纤维蛋白-PADM移植复合物行体内构建.于移植后2周、4周、8周、12周取出重建的阴道组织进行大体观察,并分别进行伊红-美蓝染色(HE)、Van Gieso(VG)染色和广谱角蛋白AE1/AE3免疫组化染色,以动态观察重建阴道组织生长情况及PADM降解情况.重建术后12周用透射电镜观察重建阴道组织超微结构.结果:①A组在移植后2周可见2～3层细胞的上皮形成;移植后4周细胞层数增加,但细胞排列无极向;移植后8周、12周上皮层结构接近正常小鼠阴道上皮层结构.B组移植后2周上皮结构即接近正常小鼠阴道上皮结构;移植后4周、8周、12周上皮层结构基本同移植后2周,但细胞形态更加成熟,极向更为明显.移植后12周A组PADM部分区域结构不完整,B组PADM仍保持基本轮廓.②AE1/AE3免疫组化染色证实了重建阴道的上皮化.③B组透射电镜观察可见上皮细胞之间存在桥粒连接,上皮细胞与基底膜之间有半桥粒连接.上皮层下见成纤维细胞、无髓神经纤维与毛细血管.结论:利用PADM进行原位组织构建与体内构建在实验动物体内均能够完成阴道重建.在技术成熟的条件下,体内构建法比原位组织构建法更适合于进行阴道重建.     

TGF-β介导盆腔淋巴管放射性纤维化作用机制的研究

目的:探讨转化生长因子-β(TGF-β)介导盆腔淋巴管放射性纤维化作用的机制。方法:20只雌性新西兰大白兔随机分成空白对照组(Sham组)、照射后4周组、照射后12周组和照射后16周组。除Sham组外,其余各组大白兔均给予放射线单次、大剂量照射。实验第4周、第12周和第16周末用水合氯醛麻醉各组大白兔,解剖,取盆腔淋巴管,染色光镜下分别观察盆腔淋巴管组织病理变化。提取盆腔淋巴管组织,采用蛋白印迹法检测TGF-β、缺氧诱导因子-1α(HIF-1α)和血管内皮生长因子(VEGF)的表达变化。结果:Sham组大白兔盆腔淋巴管组织中细胞排列整齐,无炎性细胞浸润;照射后4周可见少量炎性细胞浸润和水肿;照射后12周可见红细胞和巨噬细胞聚集,大量炎性细胞浸润、水肿显著;照射后16周可见管壁增厚、炎性细胞浸润明显,胶原增生明显。Azan染色Sham组盆腔淋巴管组织中未见纤维化表达,照射后4周大白兔盆腔淋巴管组织中少见蓝色纤维化表达,照射后12周和16周直肠组织中可见大量纤维化表达。盆腔淋巴管组织中TGF-β蛋白表达随照射后时间的延长表达增加,核内HIF-1α蛋白以及细胞浆内VEGF蛋白表达也随照射后时间的延长表达增加。结论:照射增加TGF-β蛋白表达可能与HIF-1α和VEGF蛋白相关,TGF-β可能通过影响HIF-1α从而调控盆腔淋巴管放射性纤维化。     

补片在女性盆底重建手术的应用-18例临床分析

目的初步探讨补片(mesh)在女性盆腔脏器脱垂手术重建盆底功能中的应用情况。方法我院妇科2004年3月～2005年4月期间共有18名患者因盆腔器官脱垂应用补片(mesh)进行盆底修补和重建。平均年龄68.6岁(48～78岁)。阴道前壁膨出17例,子宫脱垂15例,阴道后壁膨出12例。18例患者中14例行经阴式子宫切除术,1例行开腹全子宫切除术,1例保留子宫,2例已行子宫切除手术。同时行阴道前后壁修补术17例,单行阴道后壁修补术1例。单独置入阴道前壁补片11例,同时置入阴道前壁和后壁补片6例,单独置入阴道后壁补片1例。2例术中同时行阴道穹隆骶棘韧带悬吊术,4例术中行后路吊带阴道穹隆骶骨固定术。结果18例患者总手术时间平均为116.2min(85～150min),其中放置补片的时间平均15min。术中出血平均176ml(100～300ml)。术后恢复良好,术后住院时间5.4d(5～9d)。平均随访13.1个月(6～19个月),发现4例补片侵蚀阴道黏膜,发生率为22.2%,其中1例为前壁补片,此补片较大,为梯形补片,大小为5cm×12cm;3例为后壁补片。无补片感染发生。3例(16.7%)患者出现脏器膨出复发,1例阴道前壁膨出复发Ⅲ期,1例阴道前壁膨出复发Ⅰ期,1例阴道后壁膨出复发Ⅰ期。结论补片在女性盆底重建手术中的应用,方法简单,操作容易,不延长手术时间,患者耐受性好,但补片放置方法有待进一步探讨。     

组织工程医用生物补片用于阴道重建的动物实验研究

目的 观察应用组织工程医用生物补片(一种脱细胞真皮基质材料)在实验动物体内进行阴道重建的效果.方法 对12只中国小型实验猪行阴道全切除术,应用组织工程医用生物补片行阴道重建术,分别于术后1、2、4、6、8、12周每次选择2只实验猪切除全层阴道,并以其中2只实验猪阴道切除术中切除的正常阴道组织为对照.对阴道重建术后不同时间切除的阴道组织行HE染色和Van Gieson(VG)染色,以观察和评价阴道各层组织的生长状态;采用上皮广谱角蛋白单克隆抗体AE1/AE3、平滑肌α肌动蛋白(α-actin)单克隆抗体进行免疫组化染色,以证实重建阴道是否存在上皮组织和平滑肌组织;于重建术后1、12周行透射电镜检查,观察阴道组织超微结构的变化;于重建术后12周应用组织浴槽对离体阴道组织进行药物和电刺激,以评价阴道平滑肌的收缩功能.结果 (1)阴道重建术后1周,可见阴道黏膜覆盖近2/3,光镜下观察,阴道上皮层数少,仅1～2层;电镜下观察,上皮细胞排列疏松,不规则.阴道重建术后4～6周,可见黏膜上皮层数增多,达4～5层.重建术后12周,大体上很难与正常阴道区分,上皮广谱角蛋白单克隆抗体AE1/AE3免疫组化染色结果与HE染色结果一致;电镜下观察,阴道上皮细胞分层分化良好,排列有序,细胞的相邻面有桥粒连接.(2)VG染色、免疫组化染色显示,阴道重建术后4周,开始出现散在的平滑肌细胞,此后逐渐形成排列均匀的肌束.(3)阴道重建术后12周,重建的阴道与正常阴道组织对KCl刺激均能产生收缩波,收缩反应强度变化相似,分别为(2.96±0.29)和(3.14±0.30)g;对于不同电压、不同频率的电刺激,当电压固定、频率逐渐升高时,两者收缩反应强度变化分别为(3.43±0.34)和(4.65±0.73)g;当频率固定、电压逐渐升高时,两者收缩反应强度变化则分别为(4.92±0.38)和(4.89±0.44)g.结论 组织工程医用生物补片是在实验动物体内进行阴道重建较理想的材料,重建术后3个月基本可以完成组织重建.     

Comparison of host response to polypropylene and non-cross-linked porcine small intestine serosal-derived collagen implants in a rat model

OBJECTIVE: To compare the host response, architectural integration and tensile strength of polypropylene and porcine small intestine submucosa-derived implants in a rat model. DESIGN: Experimental study. SETTING: Center for Surgical Technologies, Faculty of Medicine, Katholieke Universiteit Leuven, Belgium. SAMPLE: Forty-eight adult male Wistar rats weighing 220-250 g randomised to receive either implant. METHODS: Full thickness abdominal wall defects were primarily repaired with polypropylene mesh (Marlex) (MX group) or porcine small intestine submucosa (Surgisis) (SIS group). Animals were sacrificed at 7, 14, 30 and 90 days after implantation. MAIN OUTCOME MEASURES: The presence of herniation, infection and intra-peritoneal adhesions. Change in thickness and tensile strength of implant. Histopathological and immunohistochemical appearances of inflammatory response and collagen deposition. RESULTS: Implants from the SIS group showed a short term increase in thickness in the first 14 days. Formation of adhesions was significantly more intense in the MX group at 30 days, and more extensive in the SIS group at 90 days. Tensile strength increased over time in both groups but was significantly lower in the SIS group than the MX group at 30 days. Implants in the MX group showed a more pronounced inflammatory response and more pronounced new vessel formation than the SIS group. Collagen formation was initially more fibrous and better organised in the MX group but became greater in the SIS group at 90 days. CONCLUSIONS: Biologically derived implant material induced a less pronounced inflammatory response and differences in collagen deposition. At 30 days tensile strength was weaker in the biological implant group but was equivalent by 90 days. These differences may have implications for the in vivo performance of the materials.     

Pelvic floor muscle functioning in women with vulvar vestibulitis syndrome

Vaginal sEMG biofeedback and pelvic floor physical therapists' manual techniques are being increasingly included in the treatment of vulvar vestibulitis syndrome (VVS). Successful treatment outcomes have generated hypotheses concerning the role of pelvic floor pathology in the etiology of VVS. However, no data on pelvic floor functioning in women with VVS compared to controls are available. Twenty-nine women with VVS were matched to 29 women with no pain with intercourse. Two independent, structured pelvic floor examinations were carried out by physical therapists blind to the diagnostic status of the participants. Results indicated that therapists reached almost perfect agreement in their diagnosis of pelvic floor pathology. A series of significant correlations demonstrated the reliability of assessment results across muscle palpation sites. Women with VVS demonstrated significantly more vaginal hypertonicity, lack of vaginal muscle strength, and restriction of the vaginal opening, compared to women with no pain with intercourse. Anal palpation could not confirm generalized hypertonicity of the pelvic floor. We suggest that pelvic floor pathology in women with VVS is reactive in nature and elicited with palpations that result in VVS-type pain. Treatment interventions need to recognize the critical importance of addressing the conditioned, protective muscle guarding response in women with VVS.     

Pelvic floor muscle functioning in women with vulvar vestibulitis syndrome

Vaginal sEMG biofeedback and pelvic floor physical therapists' manual techniques are being increasingly included in the treatment of vulvar vestibulitis syndrome (VVS). Successful treatment outcomes have generated hypotheses concerning the role of pelvic floor pathology in the etiology of VVS. However, no data on pelvic floor functioning in women with VVS compared to controls are available. Twenty-nine women with VVS were matched to 29 women with no pain with intercourse. Two independent, structured pelvic floor examinations were carried out by physical therapists blind to the diagnostic status of the participants. Results indicated that therapists reached almost perfect agreement in their diagnosis of pelvic floor pathology. A series of significant correlations demonstrated the reliability of assessment results across muscle palpation sites. Women with VVS demonstrated significantly more vaginal hypertonicity, lack of vaginal muscle strength, and restriction of the vaginal opening, compared to women with no pain with intercourse. Anal palpation could not confirm generalized hypertonicity of the pelvic floor. We suggest that pelvic floor pathology in women with VVS is reactive in nature and elicited with palpations that result in VVS-type pain. Treatment interventions need to recognize the critical importance of addressing the conditioned, protective muscle guarding response in women with VVS.     

Tissue reactions to absorbable ligating clips

Scanning electron microscopy was used in a comparative ultrastructural study of biodegradable ligating clips, the Absolok (polydioxanone) and the Lactomer (copolymer of glycolic and lactic acids), implanted subcutaneously in rabbits. The inflammatory response and tissue reactions to the implanted clips and their effects on clip breakdown were studied. By the first week after implantation, numerous inflammatory cells adhered to the clip surfaces, with occasional fibroblasts present. By two weeks after implantation there was a reduction in the number of inflammatory cells, but the number of fibroblasts gradually increased, resulting in encapsulation of the clips. The thickness of the fibrous tissue capsule, formed by a variety of collagen fibers, gradually increased 5-25 weeks after implantation. Residues from the Lactomer clips were still present within the encapsulating tissue at 25 weeks. In contrast, clips enclosed in nylon pouches were totally degraded, and no residues were detectable at 25 weeks. Tissue reactions similar to those observed for nonpouched implanted clips were seen over the entire external surface of the pouches.     

Collagen deposition around polypropylene tapes implanted in the rectus fascia of female rats

OBJECTIVE: Implantation of the mesh induces a foreign-body reaction followed by the development of connective tissue that may alter tape property. The aim of our study was to evaluate the deposition of collagen in the vicinity of monofilament tension-free vaginal tape (TVT; Ethicon Inc., Johnson & Johnson) and multifilament intravaginal slingplasty (IVS; Tyco Healthcare) polypropylene tapes implanted in female rats. METHODS: The samples of the meshes (10 mg each) were implanted in the rectus fascia of 14 Wistar female rats and removed after 42 days. Collagen was extracted with 0.5 M acetic acid and subsequently with pepsin (1 mg/ml in 0.5 M acetic acid). Collagen concentration was measured using Sircol Collagen Assay (Biocolor Ltd.) and normalised for milligrams of tape weight. For histological examination, tape samples were stained with haematoxylin and eosin or with silver for type III collagen. RESULTS: The total amount of collagen extracted did not differ significantly between TVT and IVS samples. For both tapes, extraction with acetic acid yielded a higher amount of collagen (about 70%) than extraction with pepsin. On histological examination, less densely packed bundles of collagen fibres and a slightly more intense inflammatory reaction were observed with TVT compared with IVS mesh. CONCLUSION: The total amount of collagen deposited around the polypropylene mesh implanted in female rats was similar for TVT and IVS meshes, but differences were noted in the arrangement of the collagen fibres and the intensity of the inflammatory reaction.     

再生育妇女产后盆底肌康复状况观察与分析

目的:探讨再生育对盆底肌的影响和产后盆底康复干预最佳时间。方法:通过对门诊产后42天常规健康检查的女性进行问卷调查、盆底功能检查,产后3月、6月、1年盆底肌力随诊,共入组产妇426例,其中初产妇325例为初产组,二次分娩的经产妇101例为再生育组,观察比较两组盆底肌力受损情况(≤Ⅱ级),分析再生育与初产之间差异。结果:1产后42天,再生育组盆底肌Ⅰ类肌力受损率低于初产组,差异有统计学意义(P0.05);Ⅱ类肌力受损率差异无统计学意义(P0.05)。2产后3月、6月、1年两组盆底肌力受损率比较差异无统计学意义(P0.05)。3再生育组盆底肌力受损率各相邻时期组间差异无统计学意义(P0.05),产后42天与产后6月盆底肌力受损率比较差异有统计学意义(P0.01)。4初产组盆底肌力受损率产后42天、3月、6月3个时期差异有统计学意义(P0.05),产后6月和产后1年差异无统计学意义(P0.05)。结论:初产对盆底Ⅰ类肌纤维近期损伤比再生育大,再生育盆底肌的恢复过程相对初产妇缓慢。需重视产后6月内盆底肌的康复。     

Clinical and histological safety assessment of rectocele repair using collagen mesh

AIM: To clinically and histologically evaluate inflammatory response following rectocele repair using porcine collagen mesh. METHODS: Seventeen patients underwent rectocele repair using porcine collagen mesh. Inflammatory response was assessed by clinical and histological inflammatory grading pre- and postoperatively. Postoperative body temperature, complications and hospital stay was compared with 15 patients undergoing posterior colporraphy. RESULTS: Postoperative clinical examination did not demonstrate any inflammatory reaction. There were no significant changes in fibroblast count (P = 0.43), connective tissue density grading (P = 0.54), macrophage count (P = 0.20), inflammatory cell count (P = 0.48), total cell count (P = 0.51), or inflammatory grading (P = 0.87) postoperatively compared with preoperative values. Body temperature was significantly elevated for both the study and control group, although higher for the study group, postoperatively day 1 (P < 0.001). There were no significant differences in hospital stay and postoperative complications. CONCLUSION: Porcine collagen mesh was not associated with an adverse inflammatory response at clinical or histological evaluation and appears to be a safe material when used for rectocele repair.     

两种补片在全盆底重建术中应用的比较研究

目的比较两种补片（Prolift全盆底重建系统和Gynemesh聚丙烯补片）在全盆底重建术的应用情况及近期疗效,探讨更为适宜的全盆底重建手术方式。方法北京大学人民医院妇科在2007年1月-2008年4月间收治因盆腔多个部位缺陷的盆腔脏器脱垂行全盆底重建术患者31例。采用Prolift全盆底重建系统行全盆底重建术14例,Gynemesh聚丙烯补片行全盆底重建术17例。比较两组患者的一般资料、围手术期和随访情况,并进行统计学分析。结果两组的患者体重指数、绝经年龄和孕次比较,差异无显著性（P〉0．05）,Prolift组平均年龄为（63．29±9．39）岁,小于Gynemesh组的（69．35±5．16）岁（P=0．03）。Prolift组阴道前壁脱垂程度稍重于Gynemesh组（P〈0．05）。两组子宫脱垂和阴道后壁脱垂的程度比较,差异无显著性（P〉0．05）。两组患者出血量、最高体温、尿管留置天数、术后残余尿和住院时间比较,差异无显著性（P〉0．05）,手术时间Prolift组短于Gynemesh组（P〈0．05）。Prolift组随访率100％,平均随访时间（8．8±3．0）个月,1例（7．1％）术后6个月复查阴道前壁复发I期,1例（7．1％）出现后壁补片侵蚀。Gynemesh组随访率94．1％,平均随访时间（12．4±3．0）个月,4例（23．5％）患者复发,3例（17．6％）患者补片侵蚀。结论Prolift和Gy—nemesh两种补片均可用于全盆底重建,手术均安全可行。在近期疗效和并发症方面,Prolift要优于Gynemesh。     

Biocompatible properties of surgical mesh using an animal model

AIM: To study the biocompatibility of surgical meshes for use in pelvic reconstructive surgery using an animal model. METHODS: Eight different types of mesh: Atrium, Dexon, Gynemesh, IVS tape, Prolene, SPARC tape, TVT tape and Vypro II, were implanted into the abdominal walls of rats for 3 months' duration. Explanted meshes were assessed, using light microscopy, for parameters of rejection and incorporation. RESULTS: Type 1 (Atrium, Gynemesh, Prolene, SPARC and TVT) and type 3 (Vypro II, Dexon and IVS) meshes demonstrated different biocompatible properties. Inflammatory cellular response and fibrosis at the interface of mesh and host tissue was most marked with Vypro II and IVS. All type 1 meshes displayed similar cellular responses despite markedly different mesh architecture. CONCLUSIONS: The inflammatory response and fibrous reaction in the non-absorbable type 3 meshes tested (IVS and Vypro II) was more marked than the type 1 meshes. The increased inflammatory and fibrotic response may be because of the multifilamentous polypropylene components of these meshes. Material and filament composition of mesh is the main factor in determining cellular response.