医用补片在女性盆底重建的可行性和有效性

Feasibility and effectiveness of medical patch in female pelvic floor reconstruction

背景:了解补片类型、生物学及材料学特点、应用过程中的可行性、有效性以及并发症,为此项工作的开展奠定理论基础。目的:归纳总结补片类型、生物学及材料学特点,明确补片在盆底重建中应用的可行性,并掌握其在盆底修补和重建中的并发症。方法:应用计算机检索PubMed数据库(http://www.ncbi.nlm.nih.gov/PubMed)及CNKI数据库(www.cnki.net/index.htm),中文检索关键词:补片,盆底重建。英文检索关键词:biological Patch,reconstructive pelvic surgery。选择文章内容与补片类型、材料学特点及其应用效果相关,同一领域文献则选择近期发表或发表在权威杂志文章。根据纳入标准选择28篇文献用于总结归纳。结果与结论:盆底修复及重建的材料作为盆底组织替代物能替代薄弱受损的盆底筋膜组织,目前大致包括生物材料、人工合成材料两类。各种修补材料各有优缺点。选择何种材料补片的争论一直不断。综合文献显示,国内不同医疗机构应用补片治疗阴道前、后壁膨出,盆底器官膨出,压力性尿失禁等不同程度盆底功能障碍性疾病,治疗例数1～80例不等,从手术时间、补片放置时间、出血量、住院时间、术后恢复情况、修补成功率、术后残余尿量等指标显示补片的应用可行并有效,降低了术后复发率,重建了盆底功能。最常见补片相关并发症为侵蚀和感染。选择适合患者的手术方式需要根据患者的具体综合考虑。但应用哪种补片材料更佳、手术的远期疗效等均有待于延长随访时间、大规模前瞻性病例对照研究加以验证。

BACKGROUND：Understanding the type,biological and material science characteristics of the patch,as well as the feasibility,effectiveness and complications in the application process,can lay the theoretical foundation for the work.OBJECTIVE：To summarize patch types,characteristics of biology and materials science,to define the feasibility of applying patch in the pelvic floor reconstruction,and to control the complications in the pelvic floor repair and reconstruction.METHODS：PubMed database（http：//www.ncbi.nlm.nih.gov/PubMed） and CNKI database（www.cnki.net /index.htm） were searched on computer by using Chinese keywords of patch,pelvic floor reconstruction and English keywords of biological Patch,reconstructive pelvic surgery.Articles related to patch type,materials science characteristics and its application effect were included.In the same field,literatures published recently or published in the authority magazine were preferred.According to inclusive criteria,28 literatures were used. RESULTS AND CONCLUSION：As the pelvic floor tissue substitute,materials used for pelvic floor repair and reconstruction can replace the damaged pelvic fascia tissue,currently including biological materials and synthetic materials.Various repair materials have their advantages and disadvantages.There has always been controversy regarding patch material choice.Comprehensive literature shows some medical institutions applied the patch for treatment of vaginal anterior and posterior wall prolapse,pelvic organ prolapse,stress urinary incontinence and other pelvic floor dysfunction to varying degrees,the included patients ranged from 1 to 80 cases,the application of patch was showns to be feasible and effective from the operation time,patch placing time,blood loss,hospital stay,postoperative recovery,repair success rate,postoperative residual urine volume and other indicators,it reduces the recurrence rate and reconstructs the pelvic floor function.The most common complications of the patch are the erosion and infection.Specific conditions of the patients should be considered in choosing a suitable surgical approach.But which kind of patch contributes to the proximal application and betters long-term effect of surgery needs to a large-scale prospective case-control study based on a longer time of follow up.