Estudo da resposta inflamatória morfometria do colágeno nos períodos precoce e tardio entre as telas de polipropileno de alta e baixa densidades, polipropileno encapsulado com polidioxanona e revestido com celulose oxidada, e politetrafluoretileno expandido: modelo experimental em ratos
Data
2015-04-29
Autores
Maeda, Carlos Toshinori 
Orientadores
Linhares, Marcelo Moura
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: O material mais utilizado para correção de hérnias da parede abdominal é o polipropileno, e não existe uma prótese ideal para todas as situações. O presente estudo tem por objetivo comparar a resposta inflamatória e a deposição de colágeno no período precoce e tardio entre diferentes tipos de telas. Método: Oitenta ratos da linhagem Wistar submetidos à colocação de telas em posição supra-aponeurótica foram alocados em: grupo A (tela de polipropileno de alta densidade), grupo B (tela de polipropileno de baixa densidade), grupo C (tela de polipropileno encapsulada com polidioxanona e revestida com celulose oxidada) e grupo D (tela de politetrafluoretileno expandido). Estes grupos foram divididos em subgrupos precoce e tardio (eutanásia no 7° e 28° dia pós operatório, respectivamente). Foram comparados os resultados da resposta inflamatória e da análise morfométrica do colágeno entre os grupos e os subgrupos. Resultados: no subgrupo precoce, os grupo B e C apresentaram maiores médias de escore de inflamação do que o grupo A (19,6 e 20 vs 17,1; p = 0,014 e 0,001, respectivamente). No subgrupo tardio, o grupo B apresentou menor média do que os grupos A, C e D (9,3 vs 11,3; 14,5 e 12,4; p = 0,046; p<0,001 e p=0,027, respectivamente). Na comparação entre os subgrupos precoce e tardio, observou-se uma queda no escore de inflamação em todos os grupos (17,1 para 11,3, p<0,001; 19,6 para 9,3, p<0,001; 20,0 para 14,5, p=0,002 e 18,3 para 12,4, p=0,001, respectivamente para os grupos A, B, C e D). Na análise morfométrica do colágeno, no subgrupo precoce, o grupo D apresentou maior média de pixel do que o grupo B, e o grupo A (67,6 vs 55,8, p=0,004 e 52,5, p=0,022, respectivamente). No período tardio, as telas de polipropileno apresentaram maior deposição de colágeno do que as outras telas (média de 70,0 e 70,1 vs 63,4 e 66,3, respectivamente). Na comparação entre os subgrupos precoce e tardio, houve aumento da contagem de colágeno no período tardio nos grupos A e B (52,5; 70,0; p<0,001 e 55,8; 70,1; p<0,001; respectivamente). Conclusões: no período precoce a tela de polipropileno de altadensidade apresentou menor resposta inflamatória que as telas de polipropileno de baixa densidade e polipropileno encapsulada com polidioxanona e revestida com celulose oxidada; no período tardio, a tela de polipropileno de baixa densidade apresentou menor resposta inflamatória que todas as demais telas estudadas; na comparação evolutiva, todas as telas apresentaram queda nos valores de inflamação entre os períodos precoce e tardio; a prótese de politetrafluoretileno expandido apresentou maior deposição de colágeno do que os grupos com polipropileno de alta densidade e polipropileno de baixa densidade no período precoce; no período tardio, as telas de polipropileno de alta e baixa densidades apresentaram maior deposição de colágeno do que as demais; e também apresentaram aumento da deposição de colágeno entre os períodos precoce e tardio, enquanto nas outras próteses não houve aumento evolutivo do colágeno.
Introduction: The widely used material to correct abdominal wall hernia is the polypropylene, and even so, there is not an ideal prosthesis for all situations. The objective of this study is to compare early and late postoperative inflammatory response and collagen deposition between different types of meshes. Method: Eighty Wistar rats underwent surgical procedure that applied onlay surgical mesh, were divided in: group A (heavyweight polypropylene mesh), group B (lightweight polypropylene mesh), group C (polypropylene with polydioxanone mesh covered with oxidized cellulose) and group D (expanded polytetrafluoroethylene mesh). These groups were then subdivided into early and late subgroups (euthanasia was performed on the 7th and 28th post-operative day respectively). The results of the inflammatory response and morphometric collagen analysis were compared between the groups and the subgroups. Results: On the early subgroup, group B and group C presented higher mean inflammation scores than group A (19.6 and 20 vs. 17.1; p = 0.014 and 0.001, respectively). On the late subgroup, group B showed a lower average than those on groups A, C and D (9.3 vs 11.3, 14.5 and 12.4; p = 0.046; p <0.001 and p = 0.027, respectively). When comparing the early and the late subgroups, there was a decrease in the inflammation score in all the groups (17.1 to 11.3, p <0.001; 19.6 to 9.3, p <0.001; 20.0 to 14.5, p = 0.002 and 18.3 to 12.4, p = 0.001, respectively for the groups A, B, C and D). In the morphometric collagen analysis, the early group D presented a higher pixel average than group B and A (67.675 vs. 55.861, 52.591 p = 0.004 and p = 0.022, respectively). In the late period polypropylene meshes showed higher collagen deposition than the other meshes (Average 70,0 and 70,1 vs 63,4 and 66,3, respectively). When comparing the early and the late subgroups there was an increasing off collagen count in the late postoperative response in groups A and B (52.591; 70.004; p<0.001 and 55.861; 70.132; p <0.001; respectively). Conclusions: In the early postoperative period, the heavyweight polypropylene mesh showed lower Inflammatory response than the lightweight polypropylene mesh, the polypropylene mesh covered with oxidized cellulose and the expanded polytetrafluoroethylene mesh; in the late postoperative period, the lightweight polypropylene mesh showed the lowest inflammatory response from all the other meshes that were studied; in an evolutionary comparison, all the meshes showed a decreased of the inflammatory values in comparison between early and late periods; the polytetrafluoroethylene expanded prosthesis showed a higher collagen deposit than the heavyweight and lightweight polypropylene groups in the early period; In the late postoperative period, the heavyweight and lightweight polypropylene meshes showed higher collagen deposits than the others and also showed a collagen increase deposit between early and late periods, while the other meshes showed no collagen increase.
Introduction: The widely used material to correct abdominal wall hernia is the polypropylene, and even so, there is not an ideal prosthesis for all situations. The objective of this study is to compare early and late postoperative inflammatory response and collagen deposition between different types of meshes. Method: Eighty Wistar rats underwent surgical procedure that applied onlay surgical mesh, were divided in: group A (heavyweight polypropylene mesh), group B (lightweight polypropylene mesh), group C (polypropylene with polydioxanone mesh covered with oxidized cellulose) and group D (expanded polytetrafluoroethylene mesh). These groups were then subdivided into early and late subgroups (euthanasia was performed on the 7th and 28th post-operative day respectively). The results of the inflammatory response and morphometric collagen analysis were compared between the groups and the subgroups. Results: On the early subgroup, group B and group C presented higher mean inflammation scores than group A (19.6 and 20 vs. 17.1; p = 0.014 and 0.001, respectively). On the late subgroup, group B showed a lower average than those on groups A, C and D (9.3 vs 11.3, 14.5 and 12.4; p = 0.046; p <0.001 and p = 0.027, respectively). When comparing the early and the late subgroups, there was a decrease in the inflammation score in all the groups (17.1 to 11.3, p <0.001; 19.6 to 9.3, p <0.001; 20.0 to 14.5, p = 0.002 and 18.3 to 12.4, p = 0.001, respectively for the groups A, B, C and D). In the morphometric collagen analysis, the early group D presented a higher pixel average than group B and A (67.675 vs. 55.861, 52.591 p = 0.004 and p = 0.022, respectively). In the late period polypropylene meshes showed higher collagen deposition than the other meshes (Average 70,0 and 70,1 vs 63,4 and 66,3, respectively). When comparing the early and the late subgroups there was an increasing off collagen count in the late postoperative response in groups A and B (52.591; 70.004; p<0.001 and 55.861; 70.132; p <0.001; respectively). Conclusions: In the early postoperative period, the heavyweight polypropylene mesh showed lower Inflammatory response than the lightweight polypropylene mesh, the polypropylene mesh covered with oxidized cellulose and the expanded polytetrafluoroethylene mesh; in the late postoperative period, the lightweight polypropylene mesh showed the lowest inflammatory response from all the other meshes that were studied; in an evolutionary comparison, all the meshes showed a decreased of the inflammatory values in comparison between early and late periods; the polytetrafluoroethylene expanded prosthesis showed a higher collagen deposit than the heavyweight and lightweight polypropylene groups in the early period; In the late postoperative period, the heavyweight and lightweight polypropylene meshes showed higher collagen deposits than the others and also showed a collagen increase deposit between early and late periods, while the other meshes showed no collagen increase.
Descrição
Citação
MAEDA, Carlos Toshinori. Estudo da resposta inflamatória morfometria do colágeno nos períodos precoce e tardio entre as telas de polipropileno de alta e baixa densidades, polipropileno encapsulado com polidioxanona e revestido com celulose oxidada, e politetrafluoretileno expandido. 2015. 72 f. Dissertação (Mestrado em Ciência Cirúrgica Interdisciplinar) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, 2015.