生物补片在女性盆底重建术中的应用进展

The Progress in the Application of Biological Patch in Female Pelvic Floor Reconstruction

简述了生物材料的分类及目前常用的生物补片种类,并以猪小肠黏膜下层(small intestinal submucosa,SIS)为例,介绍了生物补片的成分及各自在组织修补过程中的作用机制。分析了同层数不同种类间或同种类不同层数间生物补片的力学强度的差异,得出目前应用较多的生物补片为4层的SIS,其力学强度既可达到支撑盆底组织早期修补的作用,又能同时兼顾阴道壁柔软度且富于弹性的特点。基于生物补片的力学性能及可降解特性,不是所有盆底重建部位都能用生物补片来进行修补,如在持续抗拉强度占主导地位部位的重建,如穹窿骶骨固定和重度膀胱膨出修补,合成网片可能会提供一个更好的解剖效果。而在治疗压力性尿失禁的手术中,两者的成功率相当。对于性生活活跃的患者,尤其是年轻女性,在恢复阴道壁的正常解剖结构及保留其柔软且富于弹性的功能方面,生物补片具有独特的优势。作为一种新兴材料,生物补片在盆底重建术中的应用尚处于探索阶段,但随着盆疷器官脱垂患者的年轻化,生物补片仍具有潜在的发展空间。

This paper resumes the classification of biological materials and common biological patch types at present. As a case study of porcine small intestinal submucosa（SIS）, introduces the composition of biological patches and their role in the tissue repair process. By analyzing the mechanical strength of various biological patches, it is concluded that the SIS with four layers is current application more biological patch, it not only with the enough mechanical strength to support the early repair of the pelvic floor, but also of the characteristics of the vaginal wall flexibility and full of elasticity. Based on the mechanical properties and biodegradable properties of biological patches, not all pelvic floor reconstruction can be repaired by biological patch, such as fornix sacral fixation and severe bulging bladder, where synthetic mesh may provide a better effect of anatomy. The success rate of biological patch is equivalent to synthetic mesh in the treatment of stress urinary incontinence. However, for sexually active patients, especially young women, to restore the normal anatomy of vaginal wall and retain its soft and full of elasticity, biological patch has a unique advantage. As a new material, biological patch application in pelvic floor reconstruction is still in the stage of exploration. But with the younger of pelvic organ prolapse patients, biological patch still has a potential development space.