【作者】 王小文；

【导师】 周松；

【作者基本信息】 厦门大学 ， 外科学（普外方向）， 2019， 硕士

【摘要】 目的:探讨一种新型聚己内酯Kugel补片可吸收弹力环材料在大鼠体内的安全性。方法:清洁级Wistar健康雌性大鼠80只,体重250-300g。随机分为A组(新型Kugel补片可吸收弹力环截段)和B组(普通Kugel补片不可吸收弹力环截段)。取大鼠腹部右旁正中切口长约4cm,分别将A、B两组弹力环截段(直径2mm,长20mm)植入肌后腹膜前层面,用4-0不可吸收缝合线将弹力环截段与周围组织固定,3-0不可吸收缝合线缝合皮肤切口,术后单只单笼饲养老鼠,术后观察老鼠进食、活动情况。两组分为1、3、6月及1年随机选取10只进行取材评估,分别评估其弹力环截段周围一般情况、组织病理学变化以及扫描电镜等情况。结果:1.一般情况观察A组死亡1只,原因不明;B组大鼠死亡3只,其中一只因弹力环截段刺破腹膜致肠坏死死亡,一只伤口感染死亡,另一只原因不明;余均无伤口感染、渗血情况,所有切口均Ⅰ期愈合;无肠瘘发生及皮下气肿形成。2.大体观察结果术后1个月:A、B两组弹力环截段均被少量周围组织包绕,且弹力环截段无变形,未刺破周围组织及腹膜穿透腹壁,两组无明显差异;术后3个月:A、B两组弹力环截段已基本与宿主组织整合,A组弹力环截段变软,B组弹力环截段无明显变化;术后6个月:A、B两组均可见弹力环截段完全与宿主组织整合。A组弹力环截段已变形,未降解。B组弹力环截段无变形、降解;术后1年:A、B两组均可见弹力环截段与周围组织粘连紧密。A组弹力环降解,但未刺破周围组织及腹膜。B组弹力环截段无变形、降解。3.组织学观察结果A、B组弹力环截段植入后周围组织可见明显炎症反应,随着时间的延长,炎症可逐渐消退,各个时间点组间无明显差异;两组弹力环截段植入后周围组织均可见新生血管,随时间的变化,新生血管减少,各个时间点组间无明显差异;两组弹力环截段植入后周围组织均可见少量的多核巨细胞,随时间的延长,多核巨细胞无明显变化,各个时间点组间无明显差异;两组弹力环截段植入后周围组织均可见胶原再生沉积,随着时间变化,胶原沉积增多,顺序排列,各个时间点组间无明显差异。4.扫描电镜观察结果电镜结果显示:植入1个月内:两组材料表面光滑,仅有少量组织覆盖,材料表面未见明显吸收痕迹,可见少量间皮细胞,排列杂乱无张;植入3个月时:电镜显示B组弹力环截段表面光滑,表面覆盖组织增多,未见明显吸收痕迹,而A组弹力环截段表面可见较明显凹痕,局部有被吸收征象,材料表面见组织覆盖,并有腹膜间皮组织长入,尚稀疏,且排列方向性差,表面有较多分泌物附着;植入6个月时:电镜结果显示B组弹力环截段表面仍光滑,表面覆盖组织较密,未见明显吸收痕迹。A组弹力环截段表面则可见明显被吸收痕迹,表面凹痕逐渐融合,未见离断。两组弹力环截段表面腹膜间皮细胞较前生长好,较密,但排列方向性仍然稍差,表面无明显分泌物;植入1年时B组弹力环截段表面光滑,表面覆盖组织密集,未见明显吸收痕迹。A组弹力环截段表面吸收明显,凹痕融合,可见离断面,组织周围覆盖多,两组弹力环截段表面间皮细胞排列方向性较好,与正常腹膜间皮细胞无明显差别。结论:采用以聚己内酯为主要材料的可吸收弹力环植入大鼠体内后,随着时间的推移,弹力环逐渐被降解吸收,但并不会出现普通不可吸收弹力环发生的材质逐渐变性,甚至出现断裂,损伤腹腔内脏器、血管等并发症。聚己内酯可吸收弹力环在一定时间内保留了普通弹力环的强度和弹性,且具有生物稳定性好、无毒害、可降解、炎症反应小、不引起组织变态反应等性能,故具有临床应用价值。更多还原

【Abstract】 Objective:To explore the safety of a new type of polycaprolactone Kugel patch absorbable elastic ring material in rats.Methods:Eighty healthy Wistar healthy female rats weighing 250-300 g were used.They are randomly divided into group A(Kugel elastic ring segment group)and group B(absorbable elastic ring segment group).The elastic ring segments(2mm in diameter and 20 mm in length)of the A and B groups were implanted into the posterior peritoneal layer of the muscle.the elastic ring was fixed with a 4-0 non-absorbable suture and the skin incision was sutured by 3-0 non-absorbable suture.After operation,the mice were fed in a single cage.The rats were observed for feeding and activities after operation.The two groups were randomly select 10 rats froml,3,6 months and 1 year old to evaluate tissue about the general conditions,histopathological changes and result of scanning electron microscopy of the patch elastic ring.Results:1.Observation of general conditionsThe Kugel elastic ring group had 3 rats died,which one of them died of intestinal obstruction because of elastic rings pierced the peritoneum.There also was a rat were died by infection,which had the hematoma was bruised around the wound.The other cause was unknown.The absorbable elastic ring group died one rat,which the reason is unknown.And the remaining had no wound infection,oozing,intestinal fistula and subcutaneous emphysema and all incisions healed by first stage.2.General observation resultsOne month after operation:the Kugel elastic ring group showed that the elastic ring was surrounded by a small amount of surrounding tissue,the elastic ring was not deformed,and the surrounding tissue and peritoneum were not penetrated into the abdominal wall.There was no significant difference between the absorbable elastic ring group and the Kugel patch elastic ring group.3 months after operation:the Kugel elastic ring group showed that the elastic ring had been basically integrated with the host tissue,the elastic ring was not deformed and the surrounding tissue and peritoneum were not penetrated into the abdominal wall.There had no obvious differences between absorbable elastic ring group and the Kugel patch elastic ring group.6 months after surgery:The Kugel patch elastic ring group showed that the elastic ring was completely integrated with the host tissue,and the elastic ring was not deformed and broken.The elastic ring of the absorbable elastic ring was deformed but not breaking.One year after operation:the elastic ring of the Kugel patch group showed that the elastic ring was closely adhered to the surrounding tissue,and the elastic ring was not deformed or broken.The absorbable elastic ring group elastic ring has broken,but the surrounding tissue and peritoneum were not punctured.3.Histological observation resultsThere were obviouos inflammatory reactions in both two groups in the first 3 months,and there was no significant difference between them.As time went by,the inflammation gradually subsided.What’s more,the neovascularization was observed in the two groups in the first 3 months,and the neovascularization decreased with time.A small number of multinucleated giant cells were observed around the elastic ring and there was no significant difference between the two groups.There was no significant change with multinucleated giant cells with time.The collagen regeneration and deposition were observed in the two groups and collagen deposition arraged in order were observed with time.What’s more,there may had no differences between the two groups.4.Scanning electron microscope resultsWithin 1 month of implantation:the surface of the two groups is smooth and only a little amount of tissue covered.There was no absorption marks on the surface of the material and a small amount of mesothelial cells are seen,which the arrangement is disordered.After implanted for 3 months:the surface of the Kugel elastic ring group was smooth,and the surface coverage of the tissue increased.But no obvious absorption traces were observed.The surface of another group can be seen a dent,and the surface was absorbed.The surface of the material was covered with tissue,and the peritoneal mesothelial tissue growed in and be sparse,which also had poor alignment,and has more secretions on the surface than the kugel elastic ring group.Scanning electron microscope results.After implanted for 6 months,the surface of Babsorbable elastic ring group was still smooth,the surface coverage is dense and had no obvious absorption marks.But the surface of the the Kugel elastic ring can be clearly absorbed,and the surface dents gradually merge but no break.Both group were better than previous themselves in the growth of peritoneal mesothelial cells on the surface,but the orientation was still slightly poor and there was no obvious secretion on the surface.The surface of Babsorbable elastic ring group was smooth at 1 year after implantation and the surface coverage was dense.Compared with the group talk above,the surface of the Kugel elastic ring group was obviously absorbed and the indentation was fused.The cross-section was visible and the surrounding area was covered by tissue.The mesothelial cells on the surface of the two groups were well arranged and there is no significant difference from the normal peritoneal mesothelial cells.Conclusion:The absorbable elastic ring with the polycaprolactone as main material was implanted into the rat body.It did not had degeneration like non-absorbable elastic ring or even breaks,damages the abdominal internal organs and result complications such as blood vessels.The polycaprolactone absorbable elastic ring retains the strength and flexibility of the ordinary elastic ring and has the properties of good biological stability.It also has many advantage like non-toxicity,degradability,small inflammatory reaction,no tissue allergic reaction.Therefore,it has clinical application value.更多还原