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目的探讨孕晚期行宫内手术修补胎羊腹壁缺损的可行性。方法取8只孕110～115 d的健康山羊,体重14～22 kg,随机分为两组,分别为可吸收缝线组(A组,3只)及生物型补片组(B组,5只)。两组首先切除胎羊全层腹壁分别制备大小约5 cm×1 cm及5 cm×2 cm的腹壁缺损模型后,分别采用可吸收缝线缝合及两层生物型补片修补腹壁缺损。观察术后母羊及出生后小羊一般情况;于出生后第10天处死小羊观察腹腔内粘连情况,并取切口瘢痕组织行生物力学测定和组织学观察。结果术后共3只母羊流产,其中A组1只,B组2只;其余母羊均顺利娩出小羊。A组小羊腹壁切口愈合好,瘢痕呈线形,腹腔内粘连轻;瘢痕厚度为4～5 mm。B组小羊腹壁切口均未完全愈合,腹腔内粘连轻;瘢痕厚度为3～4 mm。生物力学测定A组瘢痕组织皮条断裂力为16、20 N,B组为10、14、18 N。组织学观察示,A组瘢痕组织范围小;B组见皮肤溃疡面和其下的纤维结缔组织,伴炎性细胞浸润。结论 孕晚期行宫内手术修补胎羊腹壁缺损可行;对于腹壁缺损较小者可直接缝合修补,缺损较大者可采用生物型补片修补。
Objective To investigate the feasibility of intrauterine surgery in the second trimester of pregnancy to repair the abdominal wall defect of fetus. Methods Eight healthy goats weighing 110-115 d and weighing 14-22 kg were randomly divided into two groups: resorbable sutures (group A, group B), group B (group B), group B only). In the two groups, the abdomen defect of 5 cm × 1 cm in size and 5 cm × 2 cm in size were excised from the whole abdominal wall of the fetus. Abdominal wall defects were repaired by resorbable suture and two layers of biological patch. Observation of postoperative ewes and postnatal lamb general situation; on the 10th day after birth, the kidneys were killed to observe the intra-abdominal adhesions, and to take scar tissue biomechanical measurements and histological observation. Results A total of 3 ewes were aborted, including 1 in group A and 2 in group B. All other ewes delivered lambs successfully. A group of lamb abdominal incision healed well, the scar was linear, intra-abdominal adhesions light; scar thickness of 4 ~ 5 mm. The abdominal incisions of lambs in group B were not completely healed, and the adhesions in abdominal cavity were light. The thickness of scar was 3 ~ 4 mm. Biomechanical measurements of scar tissue in group A showed a fracture force of 16,20 N compared to 10,14,18 N in group B. Histological observation showed that the scar tissue in group A had a small range. In group B, the skin ulcers and the fibrous connective tissue under it were observed with inflammatory cell infiltration. Conclusions Intrauterine surgery in the third trimester of pregnancy is feasible to repair the abdominal wall defect of fetal sheep. For patients with smaller abdominal wall defects, suture repair can be performed directly, and those with larger defects can be repaired with bio-patch.