CAJ | 학술논문

目的：探讨在猪腹壁切口疝模型中应用菌液污染的方式制备感染型腹壁切口疝模型的可行性和聚丙烯复合脱细胞基质的新型复合补片在污染环境下耐受感染的能力。方法入组60只实验猪，随机分为3组（20例），采用切除部分腹壁肌肉的方式制备腹壁切口疝模型，后用大肠埃希菌肠液局部污染诱导产生感染病灶，形成感染窦道后，行清创手术后分别以聚丙烯-脱细胞基质材料复合补片（实验组）、单纯聚丙烯补片（对照组Ⅰ）和聚丙烯-膨化聚四氟乙烯复合补片（对照组Ⅱ）进行置入操作，术后1～12个月观察补片感染情况并取补片及周围组织，进行病理检查，以χ2检验方法对结果进行统计学分析，证实各组在污染环境下耐受感染能力的差异。结果术后观察期内实验组有1只猪出现补片感染，而对照组Ⅰ有8只猪出现补片感染，对照组Ⅱ有11只猪出现补片感染，组间存在统计学差异（P＝0．003），实验组与对照组Ⅰ之间存在统计学差异（P＝0．008），实验组与对照组Ⅱ之间存在统计学差异（P＝0．001），对照组Ⅰ与对照组Ⅱ之间无统计学差异（P＝0．342），病理检查示聚丙烯复合脱细胞基质材料的补片易于成纤维细胞的长入及新生血管的生成，感染补片细菌培养结果证实为大肠埃希菌。结论在细菌感染的环境下，相较于单纯聚丙烯补片和聚丙烯-膨化聚四氟乙烯复合补片，聚丙烯复合脱细胞基质材料的补片耐受感染能力更强，单纯聚丙烯补片和聚丙烯-膨化聚四氟乙烯复合补片耐受感染能力无明显差别，其内在的机制可能与组织易于长入及新生血管生成有关。
목적：탐토재저복벽절구산모형중응용균액오염적방식제비감염형복벽절구산모형적가행성화취병희복합탈세포기질적신형복합보편재오염배경하내수감염적능력。방법입조60지실험저，수궤분위3조（20례），채용절제부분복벽기육적방식제비복벽절구산모형，후용대장애희균장액국부오염유도산생감염병조，형성감염두도후，행청창수술후분별이취병희-탈세포기질재료복합보편（실험조）、단순취병희보편（대조조Ⅰ）화취병희-팽화취사불을희복합보편（대조조Ⅱ）진행치입조작，술후1～12개월관찰보편감염정황병취보편급주위조직，진행병리검사，이χ2검험방법대결과진행통계학분석，증실각조재오염배경하내수감염능력적차이。결과술후관찰기내실험조유1지저출현보편감염，이대조조Ⅰ유8지저출현보편감염，대조조Ⅱ유11지저출현보편감염，조간존재통계학차이（P＝0．003），실험조여대조조Ⅰ지간존재통계학차이（P＝0．008），실험조여대조조Ⅱ지간존재통계학차이（P＝0．001），대조조Ⅰ여대조조Ⅱ지간무통계학차이（P＝0．342），병리검사시취병희복합탈세포기질재료적보편역우성섬유세포적장입급신생혈관적생성，감염보편세균배양결과증실위대장애희균。결론재세균감염적배경하，상교우단순취병희보편화취병희-팽화취사불을희복합보편，취병희복합탈세포기질재료적보편내수감염능력경강，단순취병희보편화취병희-팽화취사불을희복합보편내수감염능력무명현차별，기내재적궤제가능여조직역우장입급신생혈관생성유관。
Objective To explore the feasibility of contaminated incisional hernia established with bacteria solution in a swine model,and to investigate the resistance of a novel composite polypropylene (PP)/acellular tissue matrix (ACTM)mesh against infection in a contaminated surgical field.Methods A total of 60 swine were randomized divided into three groups (n =20 ).All animals underwent partial abdominal wall muscle resection to make the incisional hernia model.Additionally,we used Escherichia coli (E.coli)intestinal juice to induce wound sinuses.After a debridement surgery,composite PP/ACTM,pure PP and PP/expanded polytetrafluoroethylene (e-PTFE)composite mesh were implanted to three groups respectively (experimental group,control group Ⅰ,control group Ⅱ).After 1 to 1 2 months,the mesh infection state was observed,and the specimens were obtained for pathological examination to compare resistance of different meshes against infection.Results Only one case in the experimental group,8 cases in control group Ⅰ and Ⅱ cases in control group II occurred mesh infection (P =0.003 ).There were significant differences between experimental group and group I (P =0.008),and between experimentalgroup and group Ⅱ(P =0.001 ).Pathological examination suggested that the composite PP/ACTM meshcould optimize fibroblastic ingrowth and promote revascularization E.coli were detected from infected meshaccording to the results of bacterial culture.Conclusions The novel composite PP/ACTMmesh have showna better infection tolerance compared with the pure PP and traditional PP/e-PTFE meshes in contaminatedcondition. The potential mechanism may include the superior fibroblasts in growth and rapidneovascularization.