管状膨体聚四氟乙烯用于组织工程支架材料的动物实验研究

目的：研究膨体聚四氟乙烯(ePTFE)植入动物体内后与机体的关系。方法：管状膨体聚四氟乙烯两端闭合，内充DMEM培养液，埋入家兔皮下，观察宿主生命情况，于术后1、2、4、6周取出标本，行大体及光镜下观察。结果：家兔在植入膨体聚四氟乙烯材料及DMEM培养液后存活情况良好，DMEM培养液在1周时即已完全无色透明；4周时膨体聚四氟乙烯与周围组织有粘连，6周时粘连紧密；光镜下观察，各时间点材料间隙均可见着色，1周时可见少量淋巴细胞浸润，无血管及组织细胞。材料内壁未见细胞附着。结论：植入膨体聚四氟乙烯材料及少量DMEM培养液对宿主动物存活无影响；管内外液体可相互交通，管状膨体聚四氟乙烯可作为组织工程化尿道的支架材料。     

Assessment of adhesion formation to intra-abdominal polypropylene mesh and polytetrafluoroethylene mesh

BACKGROUND: The development of intra-abdominal adhesions, bowel obstruction, and enterocutaneous fistulas are potentially severe complications related to the intraperitoneal placement of prosthetic biomaterials. The purpose of this study was to determine the natural history of adhesion formation to polypropylene mesh and two types of polytetrafluoroethylene (ePTFE) mesh when placed intraperitoneally in a rabbit model that simulates laparoscopic ventral hernia repair. MATERIALS AND METHODS: Thirty New Zealand white rabbits were used for this study. A 10-cm midline incision was performed for intra-abdominal access and a 2 cm x 2 cm piece of mesh (n = 60) was sewn to an intact peritoneum on each side of the midline. Two types of ePTFE mesh (Dual Mesh and modified Dual Mesh, W.L. Gore & Assoc., Flagstaff, AZ) and polypropylene mesh were compared. The rate of adhesion formation was evaluated by direct visualization using microlaparoscopy (2-mm endoscope/trocar) at 7 days, 3 weeks, 9 weeks, and 16 weeks after mesh implantation. Adhesions to the prosthetic mesh were scored for extent (%) using the Modified Diamond Scale (0 = 0%, 1 50%). At necropsy the mesh was excised en bloc with the anterior abdominal wall for histological evaluation of mesothelial layer growth. RESULTS: The mean adhesion score for the polypropylene mesh was significantly greater (P < 0.05) than Dual Mesh at 9 weeks and 16 weeks and modified Dual Mesh at 7 days, 9 weeks, and 16 weeks. Fifty-five percent (n = 11) of the polypropylene mesh had adhesions to small intestine or omentum at necropsy compared to 30% (n = 6) of the Dual Mesh and 20% (n = 4) of the modified Dual Mesh. There was a significantly greater percentage (P < 0.003) of ePTFE mesh mesothelialized at explant (modified Dual Mesh 44.2%; Dual Mesh 55.8%) compared to the polypropylene mesh (12.9%). CONCLUSIONS: Serial microlaparoscopic evaluation of intraperitoneally implanted polypropylene mesh and ePTFE mesh in a rabbit model revealed a progression of adhesions to polypropylene mesh over a 16 week period. The pore size of mesh is critical in the development and maintenance of abdominal adhesions and tissue ingrowth. The macroporous polypropylene mesh promoted adhesion formation, while the microporous nature of the visceral side of the ePTFE served as a barrier to adhesions.     

膨体聚四氟乙烯植入整复腮腺术后凹陷畸形

目的：探讨应用膨体聚四氟乙烯（ePTFE）植入腮腺切除术后凹陷畸形和预防味觉性出汗综合征（Frey综合征）的可行性.方法：11例因肿瘤行腮腺浅叶或深浅叶切除的男女患者立即在术区植入ePTFE补片并追踪观察其整复术区凹陷畸形的美容效果和防止术区Ffey综合征效果.结果：11例患者的手术切口均Ⅰ期愈合.经24～79个月随访，所有患者腮腺术区均无明显凹陷畸形，无一例发生Frey综合征.结论：ePTFE植入整复腮腺切除后凹陷畸形的美容效果良好，防止术区出现Frey综合征的效果良好。     

两种生物材料修补大鼠腹壁缺损的组织学反应

目的:观察聚丙烯(Polypropylene,PP)和复合材料(Polypropylene+ex-pandedPolytetrafluoroethylene,PP+ePTFE)修补大鼠腹壁缺损的组织学反应,客观地评价两种材料的特点,以便为临床选用材料提供一定的理论依据。方法:Wistar大鼠分为PP全层修补(PP-T)组、PP保留腹膜(PP-PR)组和PP+ePTFE全层修补(PP+ePTFE-T)组。切除1.5cm(2.0cm的前腹壁,分别以相同面积的两种补片修补缺损,于术后14,30,60和120d进行腹腔内粘连评分及组织学检查。结果:PP+ePTFE组动物术后各期腹腔粘连明显轻于PP+T组(分别P<0.05)。PP+PR组动物腹腔无粘连。术后14d,两种材料周围均以炎性反应为主,但PP+ePTFE组腹腔面反应很轻。30d后,在PP和PP+ePTFE非腹腔面周围成纤维细胞和胶原逐渐增加。PP+ePTFE材料的腹腔面逐渐形成一间皮层。结论:PP材料与组织掺和好,但与腹腔粘连重。PP+ePTFE材料既有组织掺和好,又具有抗腹腔粘连作用。腹膜是防止PP材料与腹腔脏器粘连的最好屏障。     

膨体聚四氟乙烯及其在颌面整形中的应用

膨体聚四氟乙烯 (expanded polytetrafluroethlene,e PTFE)自 80年代后期以来成为一种新兴的面部充填材料。本文对 e PTFE的材料性能、生物特性、理化特性种类及临床应用技术和在口腔颌面部整形中的应用等方面进行综述。     

降低ePTFE隆鼻术后感染发生率的临床研究

目的:寻找一种降低膨体聚四氟乙烯(ePTFE)隆鼻术后感染发生率的方法。方法:尝试将雕刻成形的ePTFE假体放入含有庆大霉素溶液的注射器内,负压抽吸使庆大霉素溶液进入材料的孔隙,然后将假体置入。结果:比较处理组与未处理组感染发生的情况,庆大霉素处理组的感染率明显低于未处理组,有显著性差异。结论:该方法是一种减少ePTFE隆鼻术后感染发生率的简便易行方法。     

Use of Autologous Costal Cartilage Combined with Expanded Polytetrafluoroethylene in Asian Rhinoplasty

BackgroundThe corresponding author's experience and recent methods employed in autologous costal cartilage grafts combined with expanded polytetrafluoroethylene (ePTFE) in Asian rhinoplasty were presented in this study.ObjectivesThe purpose of this study was to assess the outcomes of rhinoplasty performed on patients using autogenous costal cartilage grafts combined with an ePTFE implant.MethodsSeventy-five rhinoplasty cases with autologous costal cartilage grafts and an ePTFE implant were retrospectively reviewed. Graft types, complications associated with the graft itself or graft harvesting, surgical outcomes, and patient satisfaction were assessed.ResultsThe mean follow-up time post-operation was 13.5 months. A total of 42/75 patients underwent revision surgeries. Graft-related complications were found in 8% of cases, including two warped graft and four infection cases. Three individuals with infections had mild graft resorption. One patient with an infection removed the implant. Graft exposure, mobility, and substantial resorption were not recorded. A total of two cases underwent revision procedures for infection and perforation, respectively. Chest incision lengths for graft harvesting averaged 2.1 cm. No pneumothorax or significant donor-site pain was found. Donor-site scars were negligible, although two cases had hypertrophic chest scars. In general, functional and esthetic outcomes were mostly satisfactory among the assessed patients.ConclusionsRhinoplasty using autologous rib cartilage provides adequate support and sufficient cartilage amounts for correcting nasal contouring. Meanwhile, ePTFE alone for nasal dorsum augmentation safely achieves satisfactory outcomes. Rib cartilage rhinoplasty performed by an experienced surgeon yields excellent, long-lasting results with minimal risk; however, the potential for infection should be considered following revision surgery.     

膨体聚四氟乙烯补片在唇裂术后鼻畸形矫正术中的应用

目的:探索理想的唇裂术后鼻畸形矫正方法.方法:用膨体聚四氟乙烯补片加强患侧鼻翼软骨强度的方法对120例唇裂术后鼻畸形患者行鼻畸形矫正术.结果:120 例患者鼻翼塌陷畸形均得到明显改善,76例随访患者伤口愈合良好,无一例发生排异反应.结论:膨体聚四氟乙烯补片是一种理想的植入材料,运用这种材料可以使唇裂术后鼻畸形矫正达到满意的效果.     

自体鼻中隔软骨与膨体聚四氟乙烯假体联合隆鼻术

目的：探讨鼻中隔软骨与膨体聚四氟乙烯（expanded polytetrafluoroethylene,ePTFE）联合隆鼻治疗鼻尖过低、鼻孔显露的手术方法,以减少单纯假体隆鼻术的并发症。方法：采用鼻正中蝶形切口加双侧鼻翼缘切口取鼻中隔软骨,行鼻中隔软骨联合ePTFE加强型补片隆鼻术并治疗鼻尖低平。结果：术后随访1～6年,评价360例就医者手术效果,优157例,占43.6%;良196例,占54.4%;一般7例,占2%;无效果差的病例。结论：应用鼻中隔软骨联合ePTFE在隆鼻术中治疗鼻尖过低、鼻孔显露,可以明显减少单纯假体隆鼻术的并发症,效果理想。     

膨体聚四氟乙烯人工心包膜

对１８例法乐四联症患儿胸骨正中进胸，行姑息术后置入膨体聚四氟乙烯人工心包膜以替代心前区心包关闭心包腔。年龄２～７岁。再进胸行根治手术时发现，纵隔纤维粘连显著减轻，无一例损伤心脏或大血管。病理检查显示，仅少量纤维组织覆盖于人工心包膜及心脏表面，无组织细胞经薄膜微孔浸润。因其性能稳定、使用方便、效果良好，值得临床推广。