Klinge Uwe, Park Joon-Keun, Klosterhalfen Bernd
Department for General, Visceral and Transplant Surgery, University Hospital of the RWTH Aachen, Aachen, Germany.
Pathobiology. 2013;80(4):169-75. doi: 10.1159/000348446. Epub 2013 May 6.
Currently, more than 200 different textile constructions, so-called 'meshes', are available for use world-wide in the more than 20 million operations performed annually for the reinforcement of tissues. As any reintervention at the mesh-tissue compound is a surgical challenge, sometimes resulting in almost untreatable defects, huge efforts are being made to improve the biological and functional performance of the meshes. Based on numerous experimental and clinical studies in the past 20 years, our understanding of them has improved markedly. This includes the biomechanical aspects and the histopathological evaluation of the recipient tissue. Sufficiently large pores as well as structural stability in case of mechanical strain have been identified to be crucial to reduce excessive inflammation and fibrosis. Furthermore, large pores prevent bridging of the foreign body reaction through the pore and thereby help to reduce clinical adverse events as erosion, shrinkage or pain. However, with regard to the many different indications for meshes, there will never be one single ideal mesh for all purposes. To achieve an optimal performance, every construction should be designed according to the specific functional requirements, charging the surgeon to identify the best mesh for his purpose.
目前，全球有200多种不同的纺织结构，即所谓的“网片”，可用于每年进行的2000多万例用于组织强化的手术中。由于对网片-组织复合物进行的任何再次干预都是一项外科挑战，有时会导致几乎无法治疗的缺损，因此人们正在付出巨大努力来改善网片的生物学和功能性能。基于过去20年的大量实验和临床研究，我们对它们的理解有了显著提高。这包括生物力学方面以及受体组织的组织病理学评估。已确定足够大的孔隙以及在机械应变情况下的结构稳定性对于减少过度炎症和纤维化至关重要。此外，大孔隙可防止异物反应通过孔隙形成桥接，从而有助于减少诸如侵蚀、收缩或疼痛等临床不良事件。然而，考虑到网片的多种不同适应证，永远不会有一种适用于所有目的的理想网片。为了实现最佳性能，每种结构都应根据特定的功能要求进行设计，这就要求外科医生为其目的选择最佳的网片。
