Hiles Michael, Record Ritchie Rae D, Altizer Alicia M
Cook Biotech Incorporated, West Lafayette, Indiana 47906, USA.
Surg Innov. 2009 Mar;16(1):26-37. doi: 10.1177/1553350609331397. Epub 2009 Feb 17.
Biologic grafts for hernia repair are a relatively new development in the world of surgery. A thorough search of the Medline database for uses of various biologic grafts in hernia shows that the evidence behind their application is plentiful in some areas (ventral, inguinal) and nearly absent in others (parastomal). The assumption that these materials are only suited for contaminated or potentially contaminated surgical fields is not borne out in the literature, with more than 4 times the experience being reported in clean fields and the average success rates being higher (93% vs 87%). Outcomes prove to be highly dependent on material source, processing methods and implant scenarios with failure rates ranging from zero to more than 30%. Small intestinal submucosa (SIS) grafts have an aggregate failure rate of 6.7% at 19 months whereas acellular human dermis (AHD) grafts have a failure rate of 13.6% at 12 months. Chemically cross-linked grafts have much less published data than the non-cross-linked materials. In particular, the search found 33 articles for SIS, 32 for AHD, and 13 for cross-linked porcine dermis. Furthermore, the cumulative level of evidence for each graft material was fairly low (2.6 to 2.9), and only 1 material (SIS) had level 1 evidence reported in any hernia type (inguinal and hiatal). Together, biologic grafts have published evidence showing success rates better than 90% overall and more than 2000 years of cumulative implant time. Improvements in materials, techniques, and patient selection are likely to improve these numbers as this field of surgery matures.
用于疝修补的生物移植物是外科领域中一项相对较新的进展。对医学文献数据库进行全面检索，以查找各种生物移植物在疝修补中的应用情况，结果显示，其在某些领域（腹疝、腹股沟疝）应用的证据充足，而在其他领域（造口旁疝）几乎没有相关证据。认为这些材料仅适用于污染或潜在污染手术区域的假设在文献中并未得到证实，在清洁手术区域报告的使用经验是前者的四倍多，且平均成功率更高（93%对87%）。结果证明高度依赖于材料来源、加工方法和植入情况，失败率从零到超过30%不等。小肠黏膜下层（SIS）移植物在19个月时的总失败率为6.7%，而脱细胞人真皮（AHD）移植物在12个月时的失败率为13.6%。化学交联移植物的已发表数据比非交联材料少得多。具体而言，检索发现关于SIS的文章有33篇，关于AHD的有32篇，关于交联猪真皮的有13篇。此外，每种移植物材料的证据累积水平相当低（2.6至2.9），并且只有1种材料（SIS）在任何疝类型（腹股沟疝和食管裂孔疝）中有1级证据报告。总体而言，生物移植物已发表的证据表明总体成功率超过90%，累积植入时间超过2000年。随着该外科领域的成熟，材料、技术和患者选择方面的改进可能会提高这些数据。
