Erfolgreiche biokompatible Therapie von Zwerchfelldefekten im Rattenmodell

Zusammenfassung

Die Behandlung größerer angeborener Zwerchfellhernien (CDH) stellt eine anspruchsvolle Aufgabe in der Kinderchirurgie dar. In der Regel wird heute Gore-Tex^® zur Therapie von CDH eingesetzt, dies birgt jedoch das Risiko von Rezidiven, Infektionen und anderen Komplikationen. Ziel unserer Studie war es, zu analysieren, inwieweit sich Lyoplant^® – ein azelluläres, avaskuläres biokompatibles Kollagen-Mesh – für CDH im Rattenmodell eignet.

Material und Methoden Nach Intubationsnarkose und Beatmung erfolgte eine mediane Laparotomie bei jungen Wistar-Furth-Ratten mit einem Körpergewicht von 155 – 205 g. Anschließend wurde ein 1,0 × 1,0 cm großes Muskelsegment des linken Zwerchfells reseziert und der Defekt durch Implantation eines PTFE-Netzes (Gore-Tex; n = 5) oder eines Lyoplant-Netzes (n = 6) verschlossen. Zu Kontrollzwecken (Sham-Gruppe) wurde bei 2 Tieren der Defekt mittels einer Direktnaht verschlossen. Postoperativ erfolgte eine Röntgenthoraxaufnahme zur Beurteilung des Zwerchfells. Danach wurden die Tiere über 12 Wochen täglich visitiert. Nach diesem Zeitraum wurde das Abdomen der Tiere wieder geöffnet, das linke Zwerchfell auf Verwachsungen hin untersucht und anschließend für die histologische und immunhistologische Untersuchung explantiert.

Ergebnisse Alle operierten Wistar-Furth-Ratten zeigten nach dem Eingriff eine physiologische Körpergewichtsentwicklung. Während des o. g. Zeitraumes konnte kein Rezidiv der CDH radiologisch oder klinisch gefunden werden: Bei allen Tiere (PTFE- vs. Lyoplant- vs. Sham-Gruppe) zeigten sich starke Adhäsionen des linken Leberlappens zum implantierten Material. Im Gegensatz zum PTFE-Mesh konnte in der Lyoplant-Gruppe ein stetiger Gewebsumbau (Remodeling) sowie eine kontinuierliche Neovaskularisierung gefunden werden.

Schlussfolgerung Unsere Ergebnisse zeigen, dass Lyoplant zur biokompatiblen Therapie von CDH im Rattenmodell erfolgreich eingesetzt werden kann.

Abstract

Treatment of major congenital diaphragmatic hernia (CDH) is a challenging task in paediatric surgery. Gore-Tex^® is now commonly used to treat CDH, but it carries the risk of recurrences, infections and other complications. The aim of our study was to analyse to what extent Lyoplant^® – an acellular, avascular biocompatible collagen mesh – is suitable for CDH in the rat model.

Methods A median laparotomy was performed in young Wistar Furth rats with a body weight of 155 – 205 g. A defect was created by excising a 1.0 × 1.0 cm muscular segment of the left diaphragm, which was closed by implanting a PTFE mesh (n = 5), or a Lyoplant mesh (n = 6). For control purposes (sham group, n = 2), the defect was closed directly. Each rat was examined frequently for the duration of 12 weeks. After this period, the abdomen was reopened, examined for adhesions and the left diaphragm was explanted for histological examination.

Results All operated Wistar Furth rats exhibited a physiological body weight gain after the procedure. During the above period, no recurrence of CDH could be found, either radiologically or clinically. In all animals (PTFE vs. Lyoplant vs. sham group), strong adhesions of the left liver lobe to the implanted material were found. In contrast to the PTFE mesh, constant tissue remodeling and continuous neovascularisation were found in the Lyoplant group.

Conclusion Our results show that Lyoplant can successfully be used for the biocompatible therapy of CDH in the rat model. The extent to which it can also be used to treat congenital diaphragmatic defects must be demonstrated by further experimental and clinical studies.

Schlüsselwörter

biokompatibles Kollagen-Mesh - Zwerchfellhernie - Rattenmodell

Key words

biocompatible collagen mesh - diaphragmatic hernia - rat model

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