CAJ | 학술논문

目的：通过动物实验研究污染伤口植入聚丙烯网片后切口感染率和病理学变化，探讨嵌顿性腹股沟疝患者应用聚丙烯网片行疝修补术的可行性。方法大鼠分成3组，每组40只，分别为清洁植入网片组（A 组）、大肠杆菌污染不植入网片组（B 组）和大肠杆菌污染植入网片组（C 组）。在大鼠左右背部切口3 cm，A 组直接植入聚丙烯网片，B组应用大肠杆菌悬浊液污染切口30 min 后0.25%稀释碘伏冲洗切口后局部用咽拭子浸蘸做细菌培养然后直接缝合，C组如 B 组处理后植入聚丙烯网片。术后观察 A、B、C 三组伤口愈合情况和感染率，并分别于术后1、2、4、8周取出网片作病理检查。结果所有实验动物无死亡。A 组切口1期愈合，切口感染率为0；1周时网片网孔内已有纤维母细胞和纤维细胞增生，部分区域已有肉芽形成，8周时纤维细胞和胶原细胞已经排列规则致密；B、C 组细菌培养无细菌生长；B 组切口感染率7.5%（3/40），感染切口经引流换药2期愈合；C 组切口感染率10.0%（4/40），未感染之网片较清洁切口之网片同期病理有较多巨噬细胞存在；感染切口未去除网片经引流换药2期愈合，术后8周取出网片作病理检查纤维细胞和胶原细胞较规则排列，有巨噬细胞存在。结论动物实验结果表明：切口污染状态下经稀释碘伏冲洗后，植入聚丙烯网片并不增加切口感染率。提示对于嵌顿性腹股沟疝甚至发生肠坏死行肠切除肠吻合患者可以应用聚丙烯网片行疝修补术。
목적：통과동물실험연구오염상구식입취병희망편후절구감염솔화병이학변화，탐토감돈성복고구산환자응용취병희망편행산수보술적가행성。방법대서분성3조，매조40지，분별위청길식입망편조（A 조）、대장간균오염불식입망편조（B 조）화대장간균오염식입망편조（C 조）。재대서좌우배부절구3 cm，A 조직접식입취병희망편，B조응용대장간균현탁액오염절구30 min 후0.25%희석전복충세절구후국부용인식자침잠주세균배양연후직접봉합，C조여 B 조처리후식입취병희망편。술후관찰 A、B、C 삼조상구유합정황화감염솔，병분별우술후1、2、4、8주취출망편작병리검사。결과소유실험동물무사망。A 조절구1기유합，절구감염솔위0；1주시망편망공내이유섬유모세포화섬유세포증생，부분구역이유육아형성，8주시섬유세포화효원세포이경배렬규칙치밀；B、C 조세균배양무세균생장；B 조절구감염솔7.5%（3/40），감염절구경인류환약2기유합；C 조절구감염솔10.0%（4/40），미감염지망편교청길절구지망편동기병리유교다거서세포존재；감염절구미거제망편경인류환약2기유합，술후8주취출망편작병리검사섬유세포화효원세포교규칙배렬，유거서세포존재。결론동물실험결과표명：절구오염상태하경희석전복충세후，식입취병희망편병불증가절구감염솔。제시대우감돈성복고구산심지발생장배사행장절제장문합환자가이응용취병희망편행산수보술。
Objective To study contaminated wounds after implantation of polypropylene mesh in the incision by observing infection rate and pathology change,and to investigate the application feasibility of line polypropylene mesh hernia repair on patients with incarcerated inguinal hernia. Methods New Zealand rabbit is divided into three groups,each group included 40 rabbits respectively. Clean plant net group was de-fined as group A,escherichia coli contamination without planting the net was defined group B. And escherichia coli contamination plant net group was defined was group C. The incision on its back is about around 3 cm,directly into the polypropylene mesh in group A. E. coli suspension pol-luted incision after 30 minutes of 0. 25% dilute iodine volts,flushed incision after local dip in with pharyngeal swab,dipped to do bacterial culture and direct suture in group B. Similar with group B,polypropylene mesh was applied after treatment in group C. The postoperative observation of group A,B,C included wound healing and infection rates and in 1,2,4,8 weeks took mesh for pathologic examination. Results No death rab-bits was reported in all experimental animals. The grade of incision healing in A group was 1 grade,the incision infection rate was 0% . mesh cell hyperplasia of fibroblasts and fiber,parts for granulation in the mesh was found at 1 week. Collagen fiber cells had dense arrangement rules at eight weeks. No bacteria culture no bacterial growth in B and C group was found. 3 / 40 incision infection rate(7. 5% )was found in group B. The in-fection incision by switching phase was healed. 4 / 40 incision infection rate(10% )was found in group C. The mesh of uninfected cleaner incision of the mesh in the same period showed more macrophages existing. Incision infection does not remove the mesh by the drainage treatment. The mesh for 8 weeks after pathologic examination and collagen fiber cells showed more rules,the presence of macrophages. Conclusion Pollution condition of incision after dilute iodine volts flushing,implantation of polypropylene mesh did not increase the incidence of incision infection rate. For incarcerated inguinal hernia,intestinal necrosis occurs even bowel resection in patients with intestinal anastomosis. This method can be applied to polypropylene mesh hernia repair.