NaOH消蚀法制备脱细胞真皮基质修补腹壁疝*

背景：与其他疝修补材料相比，脱细胞真皮基质具有易血管化、抗感染、从而可用替代传统补片用于感染腹壁缺损重建等特点。目的：观察NaOH消蚀法制备的脱细胞真皮基质作为修补材料应用于腹疝的应用价值。方法：以全厚猪皮制成脱细胞真皮基质，45只SD雄性大鼠制备腹壁疝模型，随机数字表法分为腹壁疝组：直接缝合皮肤，Marlex网组和脱细胞真皮基质组：分别应用大小为3.5 cm×4.0 cm的Marlex网和脱细胞真皮基质缝合皮肤；观察修复后1周时有无腹壁疝发生，脱细胞真皮基质组修复后1，2，3，5，10周分别取材，其中每周各组取4只用于苏木精-伊红染色，光镜观察。修复后第5周Marlex网组和脱细胞真皮基质组各取6只用于抗张力试验。结果与结论：术后1周脱细胞真皮基质组与Marlex网组腹壁疝发生率均显著低于腹壁疝组(P < 0.001)。脱细胞真皮基质的胶原纤维无明显变化，即有少量成纤维细胞植入，术后2周可见新生血管，术后5周脱细胞真皮基质内部血管密度基本稳定。将单独脱细胞真皮基质片与Marlex网行抗张力试验，Marlex网的抗张力显著高于脱细胞真皮基质(P < 0.001)。但植入体内5周后，脱细胞真皮基质筋膜组织的抗张力高于Marlex-筋膜组织(P < 0.05)。提示复合消蚀制备的脱细胞真皮基质可以作为良好的疝修补材料。

Acellular dermal matrix prepared by NaOH-maceration for ventral hernia repair

BACKGROUND: The use of an acellular dermal matrix (ADM) may represent a new alternative to prosthetic mesh products. OBJECTIVE: To study the value of porcine ADM made by NaOH-maceration as ventral hernia-repairing material. METHODS: ADM was made from the full thick skin of the back of swines by NaOH-maceration. Forty-five male SD rats were randomly divided into three groups including ventral hernia group (n=7), ADM group (the ventral hernia repaired by 3.5 cm× 4.0 cm ADM, n=28) and Marlex mesh group (the ventral hernia repaired by 3.5 cm×4.0 cm Marlex mesh, n=10). The occurrence of ventral hernia was observed postoperatively 1 week. To evaluate ADM histology, 4 rats in ADM group were sacrificed at 1, 2, 3, 5 and 10 weeks after surgery respectively; 6 rats were respectively selected from the Marlex group and ADM group for the experiment of tension resistance at 5 weeks after surgery. RESULTS AND CONCLUSION: The occurrence of ventral hernia in ADM group and Marlex mesh group was significantly lower than that of ventral hernia group 1 week after surgery (P < 0.001), but there was no difference between ADM group and Marlex mesh group(P > 0.05). The collagen of ADM did not change much after implantation. ADMs became infiltrated with little fibroblasts by 1 week after surgery. New wessels in ADMs were found by 2 weeks after surgery. The vessel density of ADMs kept stable by 5 weeks after surgery. The Marlex had a significantly higher breaking strength than that of the ADM (P < 0.001). But 5 weeks after surgery, the tension resistance of ADM-fascial interface was higher than that of the Marlex-fascial interface (P < 0.05). ADM prepared by the maceration of NaOH can be used as the material repairing ventral hernia.