| With the increasing incidence of hernia and abdominal wall surgical diseases,especially the number of cases of inguinal hernia and incisional hernia of the abdominal wall increased significantly,the number of operations for abdominal wall hernia in China is increasing.Surgeons have a deeper understanding of the disease,and more and more attention has been paid to its treatent.In recent years,with the development of surgical techniques,the improvement of materials science,the accumulation of clinical experience and the deepening of evidence-based medicine research,the treatent of the disease has gradually developed towards standardization.This study mainly explored the role of Shanshi?xi tissue mesh combined with α-cyano n-butyl acrylate medical adhesive in the treatent of abdominal wall hernia,and at the same time,the therapeutic mechanism was explored by transcriptome method.This paper mainly includes the following four parts:Part I The inflammatory response of Shanshi?xi tissue mesh combined with α-cyano n-butyl acrylate medical adhesive to the repair of abdominal wall hernia in rats.Ninety rats were selected,of which 10 were not treated by the operation as blank control group,and the remaining 80 were treated by artificial operation to cause abdominal defects.According to the treatent methods,the rats were divided into observation group(a-cyanoacrylate butyl ester medical adhesive treatent fixation,40)and suture control group(suture fixation,40).It was found that there was no significant change in body weight before the operation,the day after operation,1 week and 2 weeks after operation and 1 month after operation in the three groups.The immediate food intake of rats in the observation group and the suture control group was significantly lower than that of the blank group.There was no significant difference in preoperative,1 week,2 weeks and 1 month postoperatively.The hemolysis test showed that the hemolysis of rats in the Shanshi?xi tissue mesh combined with α-cyano n-butyl acrylate medical adhesive group was 0.43,which was much lower than the 5% prescribed by the IOS(International Organization for Standardization).There were no significant differences in average absorbance of three groups.The results of inflammatory factors test showed that there was no significant difference in TNF-α and IL-6 among the three groups before operation.After operation,TNF-α and IL-6 in observation group and suture control group increased first and then decreased.The levels of TNF-αand IL-6 in the observation group were significantly lower than those in the suture control group on the day immediately after operation and three days after operation,concluding that the combination of Shanshi?xi tissue mesh and Kangpote medical glue is superior to direct suture in controlling inflammation.Shanshi?xi tissue mesh combined with Kangpote medical glue has excellent hemostasis and coagulation effect and does not cause hemolytic reaction to a certain extent,at the same time,it can reduce the inflammatory reaction around the incision and is suitable for inguinal hernia repair.Part II Study on the short-term biocompatibility and adhesion of Shanshi?xi tissue mesh combined with α-cyano n-butyl acrylate medical adhesive after abdominal wall hernia repair in rats.Ninety rats were selected,of which 10 were not treated by the operation as blank control group,and the remaining 80 were treated by artificial operation to cause abdominal defects.According to the treatent methods,the rats were divided into observation group(a-cyanoacrylate butyl ester medical adhesive treatent fixation,40)and suture control group(suture fixation,40).Pathological characteristics and patch adhesion at suture site 14,30 and 90 days after operation.Two months after the operation,the area of hernia patch in the observation group was higher than the suture control group significantly(P < 0.05),and the shrinkage rate was significantly lower than that in the suture control group(P < 0.05).Pathological examination showed that the patch structure was gradually blurred and eventually loosened or even degraded at 14,30 and 90 days.HE staining showed that the suture site was mainly infiltrated by inflammatory cells.The infiltration of inflammatory cells in the observation group was lighter than that in the suture control group.The infiltration of inflammatory cells in the observation group decreased gradually with the prolongation of time.However,there was no significant change in the control group.MASSON staining: The collagen fibers in the suture site of the observation group and the control group increased with time.The collagen fibers in the observation group were arranged along the longitudinal axis of the patch.At 90 days,the collagen fibers grew into the patch,while the collagen fibers in the observation group were disordered.The results showed that the effect of medical glue-fixed Shanshi?xi tissue mesh on the shrinkage area was less,and the fusion between the patch and the abdominal wall tissue was not affected.In a certain period of time,the adhesive force between the tissue patch and the abdominal wall increased with the prolongation of time.Part III Clinical application of Shanshi?xi tissue mesh combined with α-cyano nbutyl acrylate medical adhesive in inguinal hernia repair.Eighty male patients with unilateral inguinal hernia were randomly divided into an observation group and control group with 40 cases in each group.The observation group’s patients were treated with open tension-free hernia repair under the condition of continuous epidural anesthesia.The patients in the control group were fixed with α-cyano n-butyl acrylate medical adhesive,while the control group’s patients were fixed with suture patch.Neutrophil and leukocyte counts,CRP,IL-6 levels and hospitalization days,postoperative recurrence,foreign body sensation,chronic pain,complications,and quality of life were observed before operation,on the first day after operation and on the third day after operation.The results of white blood cell count showed that on the first day after the operation,the control group increased significantly compared with the experimental group(P < 0.05),and there was no significant difference between the two groups on the third day after operation.The results of neutrophil count showed that on the 1st and 3rd day after operation,the neutrophil count in the experimental group was higher and lower than that in the control group(P < 0.05).There was no significant difference in CRP expression between the two groups.Only three days after the operation,the IL-6 level in the control group was significantly higher than that in the experimental group,and there was no significant change before and on the first day after the operation.Observation and statistics showed that the hospitalization time and local foreign body sensation of the observation group and the control group decreased significantly after 3 months and 12 months(P < 0.05).There was no significant difference in postoperative complications and VAS scores on day 3.The use of medical glue to fix Shanshi?xi tissue mesh can significantly reduce the rate of foreign body sensation and early postoperative stress response,but has no significant effect on the reduction of recurrence,pain and other postoperative complications.Part IV Transcriptional effects of Shanshi?xi tissue mesh combined with α-cyano n-butyl acrylate medical adhesive on rat abdominal wall hernia repair tissueFour rats treated with medical glue and four rats treated with surgical suture were selected and their wound tissues were sequenced by transcriptome.A total of 59.69 GB data were obtained from transcriptome sequencing of the 8 rats.And 98.15% of data met the analysis requirements and were used for subsequent analysis.We screened differentially expressed genes according to the difference of expression amount more than twice and P value less than 0.05.By analyzing differentially expressed genes under two different treatents,357 genes with significant differences were obtained.Among them,163 genes were up-regulated in rats treated with medical glue and 194 in rats treated with surgical analysis.In order to study the functional effects of these differentially expressed genes,GO and KEGG enrichment analysis of these differentially expressed genes were performed.In GO enrichment analysis,a large number of inflammation-related items were obtained,such as inflammatory response,wound healing,cell response to interleukin-1,neutrophil migration,positive regulation of leukocyte migration,interaction between cytokines and cytokine receptors,among which wound healing items were the most interesting items.These results showed that the use of medical glue and surgical crevices can affect the inflammation of wound healing in different ways.KEGG enrichment analysis also significantly enriched a large number of immune-related pathways,including TNF signaling pathway,interleukin 17 signaling pathway,C-type lectin receptor signaling pathway,chemokine signaling pathway,and so on.The enrichment of these signaling pathways indicated that medical glue and surgical suture could affect the immune response of wounds.The results of transcriptome analysis showed that different treatents could affect wound healing and inflammation by affecting gene expression at the wound site. |
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