Novitsky Yuri W, Harrell Andrew G, Hope William W, Kercher Kent W, Heniford B Todd
Division of Gastrointestinal and Minimally Invasive Surgery, Carolinas Medical Center, Charlotte, NC, USA.
Surg Technol Int. 2007;16:123-7.
The search for safe and effective means of herniorrhaphies has been ongoing for more than a century. Evidence strongly supports tension-free hernia repairs in most patients, which result in a 50% reduction in a ten-year cumulative rate of hernia recurrence compared with tissue repairs. Polypropylene mesh revolutionized the field approximately 50 years ago; however, limitations of traditional polypropylene mesh have fueled the research and development of other prosthetic and biologic mesh products. Newer polyester and expanded polytetrafluoroethylene (ePTFE) products are designed to improve pliability and reduce adhesiogenic potential. Combination meshes capitalize on the ideal properties of biomaterials by strategically positioning particular mesh surfaces to selectively impede or promote tissue ingrowth. The most recent improvement in mesh products is the introduction of "lightweight" meshes. In response to mounting evidence that the traditional formulations of polypropylene meshes are over-engineered, lightweight meshes were designed with less polypropylene per surface area. Future research may prove that most meshes used currently are "mechanical overkill," which may lead to a widespread use of lightweight meshes to provide a durable repair, minimize chronic mesh-related discomfort, and improve the overall quality of life of hernia patients.
寻找安全有效的疝修补方法已经持续了一个多世纪。有充分证据支持在大多数患者中进行无张力疝修补术，与组织修补相比，其十年累积疝复发率降低了50%。大约50年前，聚丙烯网片彻底改变了这一领域；然而，传统聚丙烯网片的局限性推动了其他假体和生物网片产品的研发。新型聚酯和膨化聚四氟乙烯（ePTFE）产品旨在提高柔韧性并降低产生粘连的可能性。组合网片通过策略性地定位特定网片表面来利用生物材料的理想特性，以选择性地阻碍或促进组织向内生长。网片产品的最新改进是引入了“轻质”网片。鉴于越来越多的证据表明传统配方的聚丙烯网片设计过度，轻质网片的设计是每单位表面积使用更少的聚丙烯。未来的研究可能会证明，目前使用的大多数网片都是“机械过度设计”，这可能会导致轻质网片被广泛使用，以提供持久的修补效果，将与网片相关的慢性不适降至最低，并提高疝患者的整体生活质量。
