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中华疝和腹壁外科杂志(电子版)

中华疝和腹壁外科杂志(电子版) ›› 2024, Vol. 18 ›› Issue (02) : 139 -145. doi: 10.3877/cma.j.issn.1674-392X.2024.02.004

疝修补材料专栏

基底膜生物补片用于腹腔内修补大鼠腹壁缺损手术引导组织再生的研究
仲卫冬1, 仲洁2, 代京3, 程文悦3, 张剑3,†()   
  1. 1. 214400　江苏，南通大学附属江阴医院，江阴市人民医院综合普外一科
    2. 200093　上海理工大学健康科学与工程学院；200003　上海，海军军医大学第二附属医院（上海长征医院）肛肠外科
    3. 200003　上海，海军军医大学第二附属医院（上海长征医院）肛肠外科
  • 收稿日期:2024-03-01 出版日期:2024-04-18
  • 通信作者: 张剑
  • 基金资助:
    国防科技卓越青年科学基金(2019-JCJQ-ZQ-002); 国防科技基础加强计划(2019-JCJQ-JJ-069)

Study of tissue regeneration induced by basement membrane biologic mesh in IPOM abdominal wall defect repair in rats

Weidong Zhong1, Jie Zhong2, Jing Dai3, Wenyue Cheng3, Jian Zhang3,†()   

  1. 1. First Department of General Surgery, Jiangyin City People's Hospital, Affiliated Jiangyin Hospital of Nantong University, Jiangyin, Jiangsu 214400, China
    2. University of Shanghai for Science and Technology, School of Health Science and Engineering, Shanghai 200093, China; Department of Anorectal Surgery, the Second Affiliated Hospital of Naval Medical University(Shanghai Changzheng Hospital), Shanghai 200003, China
    3. Department of Anorectal Surgery, the Second Affiliated Hospital of Naval Medical University(Shanghai Changzheng Hospital), Shanghai 200003, China
  • Received:2024-03-01 Published:2024-04-18
  • Corresponding author: Jian Zhang
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仲卫冬, 仲洁, 代京, 程文悦, 张剑. 基底膜生物补片用于腹腔内修补大鼠腹壁缺损手术引导组织再生的研究[J]. 中华疝和腹壁外科杂志(电子版), 2024, 18(02): 139-145.

Weidong Zhong, Jie Zhong, Jing Dai, Wenyue Cheng, Jian Zhang. Study of tissue regeneration induced by basement membrane biologic mesh in IPOM abdominal wall defect repair in rats[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2024, 18(02): 139-145.

目的

观察研究基底膜生物补片应用于腹腔内修补（IPOM）大鼠腹壁部分层次缺损手术引导腹壁组织再生的过程。

方法

选取21只健康大鼠，建立腹壁部分层次缺损模型。3只作为对照组观察造模效果；18只在造模后，分别用4层和12层基底膜补片进行修补，每组各9只，于术后2、3、4周各取3只大鼠处死取其修复区及其周围组织进行观察，通过大体观察、组织病理染色、新生血管标记和间皮细胞免疫荧光标记，观察研究生物补片在修复早期引导腹膜和组织再生的基本过程和机制。

结果

补片植入术后2周的大体观察和新生血管标记结果表明基底膜生物补片显著促进组织的血管化，新生血管从补片网孔处向周围蔓延发散形成血供网络；HE和马松染色表明补片腹壁侧和腹腔侧有明显组织再生，新生组织从补片网孔处向周围蔓延，覆盖、包裹补片；间皮细胞免疫荧光标记表明，在腹腔侧新生组织表面形成扁平的连续间皮细胞层，即腹膜再生。

结论

IPOM腹壁修复中，基底膜生物补片在早期可以引导组织和腹膜再生，新生组织和血管通过网孔从腹壁侧向腹腔侧蔓延，并在补片表面形成组织层和连续的间皮细胞层，可以有效防止补片与内脏粘连的发生。

关键词: 基底膜, 生物补片, 腹腔内补片修补术, 腹膜再生, 间皮细胞
Objective

To observe and study the process of peritoneal regeneration induced by basement membrane biologic mesh in rats with partial level defects in the abdominal wall via intraperitoneal onlay mesh (IPOM).

Methods

Twenty-one healthy rats were selected for the model construction of partial-level defects of the abdominal wall. After modeling, three rats were used as a control group to observe the modeling effect. Eighteen rats were repaired with 4-layer and 12-layer basement membrane biologic mesh, 9 rats in each group. At 2, 3 and 4 weeks postoperatively, three rats were killed to obtain and observe the repair area and its surrounding tissues. The peritoneal reconstruction and tissue repair process in early stage were evaluated by gross observation, histopathological staining, neovascularization labeling, and immunofluorescence labeling of mesothelial cells.

Results

Gross observation and neovascularization labeling two weeks after implantation showed that basement membrane biologic mesh could promote tissue vascularization. The neovascularization spread from the pore of mesh to the surrounding areas as blood supply. HE and Masson staining demonstrated significant tissue regeneration on the ventral wall side and peritoneal side of the mesh, with new tissue spreading peripherally from the mesh, and gradually cover and wrap the mesh. Immunofluorescence labeling of mesothelial cells demonstrated the formation of a flat, continuous layer of mesothelial cells on the surface of the new tissue on the peritoneal side, that is peritoneal regeneration.

Conclusion

During IPOM abdominal wall repair, the basement membrane biologic mesh can guide tissue regeneration and peritoneal reconstruction at an early stage. The new tissue spreads from the abdominal wall side to the abdominal cavity side through the mesh pores. Tissue layer and a continuous mesothelial cell layer was formed on the surface of the biologic mesh, effectively preventing the occurrence of adhesion of the mesh to the internal organs.

Key words: Basement membrane, Biologic mesh, Intraperitoneal onlay mesh (IPOM), Peritoneal regeneration, Mesothelial cells
图1 大鼠腹壁缺损造模以及4层和12层基底膜生物补片植入腹腔后不同时间的大体观察注：1A大鼠腹壁缺损造模及造模后腹腔内的大体观察（1Aⅰ造模时；1Aⅱ造模后2周）。1B 4层基底膜生物补片网孔处的血管和组织再生（1Bⅰ植入2周；1Bⅱ植入3周；1Bⅲ植入4周）。1C 12层基底膜生物补片网孔处的血管和组织再生（1Cⅰ植入2周；1Cⅱ植入3周；1Cⅲ植入4周）。
图2 基底膜补片植入腹壁缺损大鼠腹腔后组织的新生血管免疫组化标记（CD31+）注：黑色箭头指示为新生血管，黄色虚线范围为补片。2A、2B免疫组化大视野图片。2C腹腔侧新生组织和血管。2D腹壁侧新生组织和血管。
图3 基底膜补片植入腹壁缺损大鼠腹腔后组织的HE和Masson染色注：黄色虚线范围为补片。3A补片网孔周围的HE染色图片（3Aⅰ）和放大图（3Aⅱ），黑色箭头指示为新生组织扩散方向。3B补片网孔远端的HE染色图片（3Bⅰ）和放大图（3Bⅱ）。3C补片网孔远端的Masson染色图片（3Cⅰ）和放大图（3Cⅱ）。
图4 基底膜补片植入腹壁缺损大鼠腹腔后4周组织的HE染色注：部细胞从补片表面向补片内部浸润，HE染色图片（4A）和放大图（4B）。
图5 基底膜补片植入腹壁缺损大鼠腹腔后补片表面的新生组织和间皮细胞标记荧光图注：5A组织切片免疫荧光图片（5Aⅰ）和放大图（5Aⅱ），绿色为间皮细胞（Pan-CK），蓝色为细胞核（DAPI）。5B激光共聚焦扫描电镜对补片表面细胞标记的z轴层扫平面图（5Bⅰ）和三维重构截面图（5Bⅱ），绿色为间皮细胞（Pan-CK），红色为鬼比环肽标记的细胞骨架肌动蛋白（F-actin）。
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