生物补片在无张力疝修补中的应用

Application of biological patch in tension-free hernioptasty

无张力疝修补为当前治疗腹股沟疝的主要手术方式。该方式具有创伤小、切口无张力、操作简便、解剖分离少、患者疼痛轻、修补后恢复快及住院时间短等优点。尤其是经前路的腹膜前修补,目前被认为最符合生理解剖的修补方法。关于补片的材质对疝修补手术后的影响长期以来一直是一个被忽视的话题,但近期大量的研究结果表明,补片的质量和网孔孔径的大小对腹壁的修补和重建关系重大。聚丙烯补片以其稳定性强、强度高、生物惰性好以及易操作等特性已成为目前应用最广的一种人工合成材料的疝补片,但聚丙烯补片在应用中也存在着一些问题,会引起较强的组织异物反应,引起一些潜在的危害如慢性炎症,腹壁顺应性减低等。因此应结合患者的情况选择轻质量、材质柔软、大孔径的补片,减少并发症的发生。超薄轻质补片更柔软、更透明、操作容易,透过网片能清楚地观察到网片后方的神经和韧带等组织,可预防误伤,提高了修补中的易操作性,并且便于网片的正确放置,减少了修补后疼痛的发生率,而且网片的结构更有利于成纤维组织的长入,能很好地适应患者修补后因体位变动和肌肉收缩而产生的纵向和横向移动,患者修补后的不适感也极大地降低等优点。

Tension-free hernioptasty is a major method for treating inguinal hernia, characterizing by less wound, tension-free incision, sample processing, less dissection and separation, mild pain, rapid recovery, and short length of stay. In particular, transabdominal preperitoneal inguinal hernioplasty is considered as the most ideal method at physiologicoanatomical level. However, the effect of patch materials on postoperative recovery is generally ignored for a long time. Recent studies demonstrate that patch weight and mesh diameter are important factors for abdominal wall repairing and reconstruction. Polypropylene patch, characterizing by strong stability, high intensity, great unreactiveness, and sample processing, has become a major material for hernioptasty. However, there are still some problems of clinical application, including that polypropylene patch may induce intensive foreign body reaction and chronic inflammation as well as compliance decreasing of abdominal wall. Therefore, polypropylene patch should be chosen according to patient requirement, i.e., light, soft, and wide-aperture patch, so as to reduce onset of complication. Nerve and ligament tissues could be clearly observed from light and soft patch, and this might and prevent hurt by mistake, improve repairing operability, enhance correct putting of patch, and decrease incidence of pain. Furthermore, the structure was beneficial for in-growth of fiber tissue, longitudinal and transversal movement induced by body position alternation and muscle contraction, and reduction of discomfortableness.