腹壁疝手术改进与修复材料学发展对疝外科的挑战  

Challenges of surgical techniques improvement for abdominal hernia and repair materials development to hernia surgery

作　　者：唐健雄[1] 李绍杰[1] Tang Jianxiong;Li Shaojie(Department of Hernia and Abdominal Wall Surgery,Huadong Hospital,Fudan University,Shanghai 200040,China)

机构地区：[1]复旦大学附属华东医院疝和腹壁疾病治疗与培训中心,上海200040

出　　处：《中华消化外科杂志》2019年第11期1005-1009,共5页Chinese Journal of Digestive Surgery

基　　金：科技部国家重点研发项目(YS2016YFGX010183);上海申康医院发展中心临床科技创新项目(SHDC12016123)。

摘　　要：疝修补手术通过修复腹壁缺损和恢复腹壁功能,最终提高患者的生命质量。随着外科基本理论、解剖概念、手术技术和修复材料的革新,疝外科取得了巨大发展,但其治疗基本原则没有改变。近20年,我国疝外科进入全面快速发展时期,在诊断与治疗、手术技术、手术数量等方面都呈现飞跃式发展,同时又建立了培训、注册及不良事件监测等一系列临床质量控制体系,使我国疝外科整体水平走在世界前列。目前,腹壁疝手术方式百花齐放、发展迅猛,不同层次、不同入路以及不同材料的运用在患者个体化治疗中体现出良好的临床效果。目前还没有一种修补材料能够符合“理想补片”的要求。合成材料的植入虽然大幅度提高疝临床疗效,但异物永久性存在的不足也给患者带来中远期并发症的可能;而以“组织诱导性生物材料”为代表的一系列可吸收材料更接近人体组织,可能代表了疝外科材料学发展的方向,但目前仍需要长期的随访结果来证实其临床效用。The purpose of hernioplasty is to repair defects and restore abdominal wall function,and ultimately to improve the quality of patients′life.With the innovation of basic theories,anatomical concepts,surgical techniques and repair materials,hernioplasty has made tremendous progress,but its basic principles of treatment have not changed.In recent 20 years,hernia surgery in China has entered a period of compre hensive and rapid development,showing a leap in the level of diagnosis and treatment,surgical technology,the number of operations and other aspects.Meanwhile,a series of clinical quality control systems,such as training,registration and adverse event monitoring,have been established,making China the top level of the world as a whole.At present,the surgical methods of abdominal wall hernia are flourishing and developing rapidly.The application of different levels,different approaches and different materials in the treatment of individualized patients has shown good clinical results.Of course,there is no repair material that meets the requirements of“ideal patch”.Although the implantation of synthetic materials has greatly improved the clinical effect of hernia,the permanent presence of foreign mate rials also brings about the possibility of long term complications.A series of absorbable materials represented by“tissue induced biomaterials”are closer to human tissues,which may represent the direction of the development of hernia repair materials,but long term follow up results are still needed to confirm their clini cal efficacy.

关 键 词：疝 腹壁疝 手术 材料学 

分 类 号：R65[医药卫生—外科学]