Schumpelick V, Klosterhalfen B, Müller M, Klinge U
Chirurgische Klinik, RWTH Aachen.
Chirurg. 1999 Apr;70(4):422-30. doi: 10.1007/s001040050666.
Repair of incisional hernias requires the extensive implantation of alloplastic materials. The extent of the scar tissue is markedly regulated by the amount and structure of the incorporated material and is responsible for the increased rate of local wound complications. Correspondingly, minimization of the alloplastic implants should be favorable. In a randomized, prospective clinical study, the early results were compared after implantation of either a minimized, low-weight (26.8 g/m2) mesh with a pore size of 5 mm or a common, heavy-weight (90.2 g/m2 polypropylene) mesh with a pore size of 0.8 mm. Indicators for clinical suitability were the rate and volume of seroma, subjective paraesthesia, physical capability, abdominal wall compliance, and the histologically analyzed tissue reaction of samples removed on the occasion of revision operations. As result, the optimized, low-weight mesh showed a remarkable decrease in the rate of seroma, patient complaints, less restriction of abdominal wall mobility, and improved abdominal wall compliance as verified by 3D stereography. These clinical findings corresponded to a pronounced decrease in inflammation and scar reaction, indicating improved incorporation of the alloplastic material. No other major complications except for one recurrence have been found.
切口疝修补需要广泛植入异体材料。瘢痕组织的范围明显受植入材料的数量和结构调节，并导致局部伤口并发症发生率增加。相应地，尽量减少异体植入物应是有益的。在一项随机、前瞻性临床研究中，比较了植入最小化、低重量（26.8 g/m²）、孔径为5 mm的网片或普通、高重量（90.2 g/m²聚丙烯）、孔径为0.8 mm的网片后的早期结果。临床适用性指标包括血清肿的发生率和体积、主观感觉异常、身体能力、腹壁顺应性以及翻修手术时取出样本的组织学分析组织反应。结果显示，经三维立体摄影验证，优化后的低重量网片血清肿发生率显著降低，患者投诉减少，腹壁活动受限减轻，腹壁顺应性改善。这些临床发现与炎症和瘢痕反应明显减轻相对应，表明异体材料的整合得到改善。除1例复发外，未发现其他严重并发症。
