| Part 1:A retrospective study on clinical data of 79 cases with abdominal wall weaknessObjectiveTo analyze the clinical characteristics,diagnosis,treatment and follow-up of patients with abdominal wall weakness retrospectively,and to further explore the ideal surgical mode and material selection of patients with abdominal wall weakness.MethodsA total of 79 cases of patients with abdominal wall weakness admitted to the Department of Hernia and Abdominal Wall Surgery,Beijing Chaoyang Hospital,Capital Medical University from January 2010 to January 2020 were collected retrospectively.After preoperative imaging examination and preoperative preparation,surgical treatment was performed.Statistical analysis was conducted on the characteristics of abdominal wall weakness,clinical manifestations,surgical procedures,selection of repair materials and follow-up.Telephone follow-up and other methods were adopted.SPSS 23.0 was used for statistical analysis,and P<0.05 was statistically significant.Results(1)Incidence:79 patients included 45 males and 34 females.Patients with weak abdominal wall had different causes,such as iatrogenic weakness or absence of abdominal wall fascia in 43 cases(54.43%),traumatic weakness or absence of abdominal wall fascia in 21 cases(26.58%),viral infection in 9 cases(11.40%),congenital factors in 6 cases(7.59%),and the course of disease was 6.3±3.6 years(3-11 years).(2)Clinical features:iatrogenic weakness or absence of abdominal wall fascia occurs after thoracic,lumbar,aortic,and renal surgery.During previous surgery,the intercostal nerve may be injured during the separation operation,leading to demulsification of the abdominal wall muscle supplied by the nerve,resulting in weakness of the abdominal wall muscle;The same pathophysiological mechanism can be found in iatrogenic abdominal wall tissue injury.Varicella-zoster virus(VZV),which is latent in the body,causes herpes zoster to invade the intercostal nerve,and the corresponding motor nerve paralysis can lead to the involvement of the abdominal wall muscle tissue in the area innervated by the nerve,and then cause the abdominal wall to bulge and appear the clinical manifestation of abdominal wall weakness.During the embryonic development,the closure of the embryonic body cavity may cause the congenital abdominal wall to bulge,showing the weakness of the congenital abdominal wall,which is relatively rare clinically.(3)Diagnosis:All 79 patients were diagnosed with abdominal wall weakness by medical history,physical examination and imaging examination.Preoperative CT examination showed clear defects in 35 patients(44.30%),while preoperative CT examination showed no obvious defects in the other 44 patients(55.70%),manifested as weak abdominal wall and overall bulging.(4)Treatment:All patients underwent open surgery,among which 34(43.04%)underwent Sublay procedure,27(34.18%)underwent Stoppa procedure,14(17.72%)underwent Onlay procedure,and 4(5.06%)underwent tissue suture procedure.In terms of repairing materials,51 cases(64.56%)of polypropylene,13 cases(16.46%)of acellular mechanism materials and 10 cases(12.66%)of polyvinylidene fluoride materials were used.(5)Follow-up:66 patients were followed up at different times,the follow-up rate was 83.54%,and the median follow-up time was 48 months(6-120 months).There were 4 patients with recurrence(4/66),the recurrence rate was 6.06%.Superficial incision infection occurred in 5 patients(5/79),and the incidence of superficial infection was 6.33%.Two patients were followed up with deep infection and repair materials were involved(2/66),and the incidence of deep infection was 3.03%.The incidence of hematoma was 6.33%in 5 patients(5/79).The incidence of seroma was 28.79%in 19 patients(19/66)during the follow-up period.A total of 10 patients developed foreign body sensation(10/66),and the incidence of foreign body sensation was 15.15%.There was 1 patient with postoperative chronic pain(1/66),and the incidence of chronic pain was 1.51%.Conclusion(1)Surgical treatment of abdominal wall weakness can achieve better therapeutic effect;(2)Surgical treatment of abdominal wall weakness can be treated with a variety of prosthetic materials;(3)The problem of foreign body sensation after the treatment of weak abdominal wall with synthetic materials was observed.Part 2:Application of acellular tissue matrix for enhancement of weak abdominal wall in animal modelsBackgroundWeak abdominal wall is an important reason for the formation of abdominal hernia,which generally refers to the local loss of abdominal wall function and appearance changes caused by the atrophy,reduction or loss of the original tissue strength of the abdominal wall,and the main causes are patient factors and factors related to surgery.Abdominal wall weakness occurs when muscle strength is reduced due to physical factors or iatrogenic injury.However,the treatment of the disease is complex.In order to investigate the role of Acellular tissue matrix(ACTM)mesh and polypropylene mesh in abdominal wall weakness,and to discuss the mechanism of enhancing abdominal wall weakness,animal model of abdominal wall weakness was established in this study.The improvement of abdominal wall strength was observed by comparing the acellular matrix patch group with the polypropylene patch group.The changes of the important factors of the representative mechanism and other indexes were compared and analyzed,and the improvement mechanism of the two kinds of patches to the weak abdominal wall was discussed.MethodsIn this study,20 healthy male experimental rabbits were used to cut the left abdominal wall motor nerves to establish a weak abdominal wall model.The left abdominal wall was the experimental group,and the right abdominal wall of the same experimental rabbit was the control group.Wound healing and swelling were observed during the observation period of 1 month after operation.The length of the bilateral abdominal wall was recorded on the 12th week after the operation,and the abdominal circumference was compared to determine whether the abdominal wall was weak.The muscle tissues of the abdominal wall of the experimental rabbits were taken out and to test,including tensile stress and tensile strain.After the animal model was successfully established,polypropylene material and acellular matrix material(ACTM)were respectively implanted into the posterior space of the left and right abdominal walls of 30 healthy animal models with weak abdominal wall,and sutured to fix the abdominal wall defects.During the observation period of 1 month after the operation,body temperature and local wound healing of the experimental rabbits were observed.At the 24th and 48th weeks after the operation,15 experimental rabbits were respectively sacrificed.We took out the abdominal wall tissue,conducted biomechanical testing and comparison of the muscle tissues of the abdominal wall on both sides,and observed histology and scanning electron microscopy(SEM).ResultsDuring the establishment of the weak abdominal wall animal model,two experimental rabbits died accidentally due to anesthesia,one died of postoperative infection,and then three rabbits were made up.All other experimental rabbits survived for more than 3 months.The length of the abdominal circumference of the non-surgical side of the abdominal wall was 17.0±0.7cm,and the length of the abdominal circumference of the weakened side was 19.0±1.2cm,indicating an average increase of 2cm in the abdominal circumference of the animal model with weak abdominal wall.The tensile stress of the weak abdominal wall group was significantly reduced to 1.116±0.221 MPa(P<0.001),and the tensile strain was significantly reduced to 9.126±2.073%(P<0.001).According to the clinical diagnostic criteria,the postoperative abdominal circumference length and biomechanical properties have confirmed that an animal model with weak abdominal wall was successfully establishment.After the implantable material was implanted into the animal model,2 rabbits in the polypropylene group died accidentally due to anesthesia and 2 rabbits in the ACTM material group died accidentally due to anesthesia,and then 4 rabbits were supplemented.After the material implantation,4 rabbits in the polypropylene group and 1 rabbit in the ACTM group occurred incision infection,which was cured after open debridement and dressing.The success rate of the two materials implanted in the body is 100%.30 experimental rabbits survived after supplementation.Compared with the PP group,the average tensile stress in the ACTM group after 24 weeks was 2.409±0.806MPa(P=1.482E-08)lower than that in the PP group after 48 weeks,and 2.319±0.486 MPa(P=3.093E-11)lower than that in the PP group after 48 weeks.After 24 weeks,the average tensile strain in the ACTM group was 15.259±6.499%higher than that in the PP group(P=2.992E-07),and after 48 weeks,the average tensile strain in the ACSM group was 15.845±6.731%higher than that in the PP group(P=3.093E-11).It should be noted that from 24 to 48 weeks,the average increase of tensile stress in the polypropylene group and the ACSM group was 1.01±0.321 MPa(P=0.004)and 1.1±0.244 MPa(P<0.001),respectively,with statistical significance.The average increase amplitude of tensile strain in polypropylene group and ACTM group was 0.111±1.195%(P=0.926)and 0.697±2.104%(P=0.743),respectively,and the change amplitude was not statistically significant.24 weeks after the operation,there was slight inflammation in the surrounding tissues of polypropylene,almost no inflammation in the surrounding tissues of ACTM,and capillary growth was also seen.SEM results showed that 24 weeks after the ACTM material was implanted,the arrangement and orientation of the fibrous tissue were relatively neat and normal,and it was also seen that the cells adhered to the ACTM material.At 48 weeks after ACTM implantation,the outer edge of the material was degraded to a certain extent,and the surrounding tissues grew in.It can be seen that the tissue structure changes little after the ACTM material is implanted,and the bundle-like structure is still tightly connected.ConclusionsThe study confirmed that abdominal wall weakness model in rabbits was successfully established.After the implantable material is implanted in the animal model,ACTM is a promising biological material to be possibly further applied in clinical surgery in patients with abdominal wall weakness. |
PDF Full Text Request