不同生物补片材料与盆底重建:应用与作用

Different biological patch materials in pelvic floor reconstruction: application and role

背景:近年来,可应用于盆底修补和重建的补片类型越来越多,但其选择和应用方法临床还没有统一的标准,对其安全及可行性还需要有更清晰的了解。目的:分析不同生物补片材料在盆底重建中应用的可行性,并对其在盆底修补和重建中的并发症进行熟练掌握,以明确其安全性。方法:运用计算机检索CNKI数据库、Pub Med数据库近10年文献,中英文检索关键词分别为"补片、盆底重建"和"biological Patch,reconstructive pelvic surgery",选取内容与补片类型、材料学特点及其应用效果有关的文章,同一领域文献选择权威杂志发表的文章或近期发表的文章,依据纳入标准纳入36篇文献进行归纳总结。结果与结论:盆底修复及重建材料能够替代薄弱受损的盆底筋膜组织,属于盆底组织的替代物。生物材料补片分为自体、同种异体、异体材料,现阶段脱细胞组织基质是主要的同种及异种移植材料,其不含特异识别位点,不易引发受者免疫排斥反应,促进了组织相容性的有效增加及感染率的极大降低,同时可能有某种复合生长因子存在,能够对细胞的生长和分化进行调节。临床也已经广泛应用了合成材料(聚丙烯)补片,但其可能引发并发症,如感染、侵蚀等,而生物材料补片一定程度避免了这些并发症,具有较高的可行性,但其安全性等还需要进一步研究。

BACKGROUND：In recent years, more and more patches can be used for the pelvic floor repair and reconstruction, but there is no uniform standard for the selection and clinical application of patches. The safety and feasibility of different patches need to have a clearer understanding. OBJECTIVE：To compare the feasibility of different biological patch materials used in pelvic floor reconstruction, and to master the complications during the pelvic floor repair and reconstruction in order to make clear the safety of patches. METHODS： A computer-based search of CNKI and PubMed was performed for articles about type, material characteristics and application of batches published in the past 10 years. The key words were “biological patch, reconstructive pelvic surgery” in Chinese and English, respectively. Articles published in authority journals or recently published were preferred. According to the inclusion criteria, 36 articles were included in result analysis. RESULTS AND CONCLUSION：Pelvic floor repair and reconstruction materials can replace damaged pelvic fascia, acting as the substitutes of the pelvic floor. Biomaterial patches are divided into autologous, alogeneic, and xenogenoust materials. At the present stage, acelular tissue matrix is the main source of alogeneic, and xenogenoust materials, which does not contain specific recognition sites, is not easy to cause receptor immune rejection, promotes tissue compatibility greatly, and reduce the infectious rate effectively. Meanwhile, there may be a composite growth factor that is able to regulate cel growth and differentiation. Synthetic patches have been widely used in clinic, but they may lead to complications, such as infection and erosion. Biomaterial patches can avoid these complications to a certain extent, and their safety, however, need further studies.