双面不对称补片在腹壁组织缺损修复中的应用

doi:10.3877/cma.j.issn.1674-392X.2024.02.002

无张力补片修补术是腹壁缺损的首选治疗方式。然而，与单纯的腹股沟疝等腹壁缺损相比，创伤、腹壁肠造口或肿瘤切除手术等因素导致的复杂型腹壁缺损近年来日益增多，对修补材料的性能提出了更高的要求。现有商用补片在临床实践中仍面临许多亟需解决的瓶颈问题，如感染、腹腔内粘连、愈合缓慢、补片移位等，难以实现缺损组织的高效修复。本文就现有商业补片和新型双面不对称高分子补片材料进行总结和阐述并对软组织修复材料领域可能面临的挑战、机遇以及未来的研究方向进行了展望。

关键词: 腹壁缺损, 补片, 双面不对称, 复合材料

Tension-free mesh repair is the preferred method for treating abdominal wall defects. However, compared to simple abdominal wall defects such as inguinal hernias, complex abdominal wall defects caused by trauma, abdominal wall stoma, or tumor resection surgeries have become increasingly prevalent in recent years, and higher requirements are placed on the performance of repair materials. Commercial meshes still face many critical challenges in clinical practice, such as infections, intra-abdominal adhesions, slow healing, and mesh displacement, making it difficult to achieve efficient repair of defective tissues. This paper presents an overview of current commercial meshes and novel double-sided asymmetric composite polymer meshes, and provides a perspective on the potential challenges, opportunities, and future research directions in the field of soft tissue repair materials.

Key words: Abdominal wall defect, Mesh, Janus, Composite materials

表1 不同材料对补片性能的影响

分类	结构成分	应用优势	参考文献
天然生物来源材料	胶原蛋白	促血管化、组织修复再生、术后抗粘连	[32]
	几丁质及其衍生物	生物相容性优异、促进创面愈合、透气性良好、药物载体	[30,33]
	明胶	促组织修复、可降解、抗感染、抗黏附	[34]
	纤维素及其衍生物	稳定的溶胀能力、化学惰性、良好的柔韧性及生物相容性、药物载体	[35，36，37]
	多酚类	氧化还原活性、促进腹壁粘合、免疫调节、抗炎症反应、促组织修复	[38，39]
	纤维蛋白	耐受性良好、抗粘连、促进间皮细胞增殖、抑制炎症细胞浸润	[40，41]
合成聚合物来源材料	甲基丙烯酰化明胶	优异的生物相容性、光固化可控反应、促组织修复	[27]
	聚乙烯醇	生物相容性好、溶胀率低、抗变形、抗粘连	[29,42]
	聚乳酸	热稳定、易加工、良好的生物降解性和生物相容性	[43]
	羟基乙酸-乳酸共聚物	良好的生物相容性、易溶解操控成型、可控降解	[44]
	聚己内酯	良好的生物相容性、长效黏附、促细胞生长支架、可降解	[45]
	聚氨酯	易于加工、良好的弹性、生物相容性、药物载体	[46]

表1 不同材料对补片性能的影响

分类	结构成分	应用优势	参考文献
天然生物来源材料	胶原蛋白	促血管化、组织修复再生、术后抗粘连	[32]
	几丁质及其衍生物	生物相容性优异、促进创面愈合、透气性良好、药物载体	[30,33]
	明胶	促组织修复、可降解、抗感染、抗黏附	[34]
	纤维素及其衍生物	稳定的溶胀能力、化学惰性、良好的柔韧性及生物相容性、药物载体	[35，36，37]
	多酚类	氧化还原活性、促进腹壁粘合、免疫调节、抗炎症反应、促组织修复	[38，39]
	纤维蛋白	耐受性良好、抗粘连、促进间皮细胞增殖、抑制炎症细胞浸润	[40，41]
合成聚合物来源材料	甲基丙烯酰化明胶	优异的生物相容性、光固化可控反应、促组织修复	[27]
	聚乙烯醇	生物相容性好、溶胀率低、抗变形、抗粘连	[29,42]
	聚乳酸	热稳定、易加工、良好的生物降解性和生物相容性	[43]
	羟基乙酸-乳酸共聚物	良好的生物相容性、易溶解操控成型、可控降解	[44]
	聚己内酯	良好的生物相容性、长效黏附、促细胞生长支架、可降解	[45]
	聚氨酯	易于加工、良好的弹性、生物相容性、药物载体	[46]

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Application of double-sided asymmetric composite meshes in abdominal wall defect repair

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Application of double-sided asymmetric composite meshes in abdominal wall defect repair