脱细胞异体阔筋膜与自体网膜修补肾损伤的对比研究

目的 探讨异体阔筋膜细胞外基质(ECM)作为肾损伤修补材料的效果.方法 24只实验犬随机分3组:组1,异体阔筋膜ECM修补,10只;组2,自体大网膜修补,10只;组3,异体阔筋膜修补,4只.组1、2于术后1、2周及术后1、2、4个月取材,组3于术后2周、2个月时取材,每组每次2只.术前及术后行血红蛋白检查,术中估算出血量,术前及处死动物前行血清.肾素及SCr检查,并分别测定左、右肾的肌酐清除率,处死动物后切取双侧.肾脏分别称重并于修补局部取材行光镜及扫描电镜检查.结果 术中出血量组2为(28.3±1.8)g,明显高于组1(18.0±2.7)g]及组3(17.7±3.1)g],差异有统计学意义;各组各时段术后血红蛋白、SCr及血清肾素检查与术前相比差异无统计学意义;各组各时段手术修补肾(左肾)与对侧正常肾(右肾)肌酐清除率相比以及双侧肾脏质量相比差异均无统计学意义.术后大体标本、光镜及电镜检查显示:组1,术后各时段补片与周围组织均无明显粘连,且补片大小形状无明显改变,无皱缩现象.随时间推移,补片逐渐变薄形成接近正常的肾包膜结构.补片下方的肾皮质在术后各时期均无明显炎性细胞浸润.组2,取材时游离患肾十分困难,随时间延长肾创面有收缩现象,创面逐渐形成包膜样结构,但较薄且与其上的大网膜无法分离.组3,术后补片与周围组织粘连明显,肾创面有明显收缩现象,局部炎性细胞浸润明显,免疫反应严重.结论 异体阔筋膜ECM可作为理想的肾修补材料.

Effect of extracellular matrix of xenogenic femoral fascia in repair of renal trauma

Objective To study the effect of extracellular matrix(ECM)of xenogenic femoral fascia which is a tissue-engineering material in repair of renal trauma.Methods Twenty-four experiment dogs were divided into 3 groups:group 1(n=10),the kidneys were repaired using ECM of xenogenic femoral fascia;group 2(n=10),the kidneys were repaired using self-omentum;group 3(n=4),xenogenic femoral fascia was used as repair materials.The animals were sacrificed separately at 1,2 weeks and 1,2,4 months after renal repair operations in group 1,2.In group 3,the animals were sacrificed separately at 2 weeks and 2 months after renal repair operations.The examinations of blood routine were performed before and after operations immediately,blood creatinine and serum renin were measured before operations and before death.The creatinine clearances of affected and contralateral normal kidneys were evaluated before death and the local areas of renal repair were studied by light and scan electron microscopy.Results In group 1,bleeding stopped rapidly and completely after the entire patch was sutured,only mild adhesions to surrounding tissues were found in various times after operations.As time passed,the repair patch was replaced by smooth neocapsule just like a normal one.In group 2,the bleeding volume in the operations was larger than the other 2 groups.It was diffieult tO separate the kidneys from the surrounding tissues.The wounds gradually contracted because of the scar forming.In group 3,there were severe immunological reactions in the patchs.Conclusion ECM of xenogenic femoral fascia is an ideal tissue-enginee rjng material for renal repair.