Klinge U, Weyhe D
Klink für Allgemeine, Visceral- und Transplantationschirurgie, Universitätsklinik der RWTH Aachen, Pauwelsstr. 30, 5207, Aachen, Deutschland,
Chirurg. 2014 Feb;85(2):105-11. doi: 10.1007/s00104-013-2592-y.
The risk for developing postoperative complications increases with the degree of surgical trauma, an altered wound healing capability of the patient due to comorbidities and environmental conditions and the selection of an inadequate implant material, the latter offering options for improvement at least in some patients. In general a mesh with large pores made of monofilaments provides a reduced surface area and causes less scarring and inflammation than those with small pores and thereby reduces the rate of scar contraction, pain and the challenge to explant a mesh from a scar bed. When placing the mesh in the abdominal cavity an additional surface coating of polypropylene should prevent the formation of a fistula between mesh and bowel. The risk of recurrence mainly depends on the extent of overlap; however, the flexibility of some meshes may increase the technical difficulties of some implants. In cases of bacterial contamination of the wound there is an increased risk for late onset mesh infection and monofilament meshes offer the best option for complete healing by conservative means. An impaired function of the spermatic cord because of the material, apart from the consequences of the surgical trauma, has not been confirmed in experimental and clinical studies. Revision of mesh sites always is a surgical challenge but could be much easier with implants which are visible in computed tomography (CT) or magnetic resonance imaging (MRI) scans.
术后并发症的发生风险会随着手术创伤程度、患者因合并症和环境因素导致的伤口愈合能力改变以及植入材料选择不当而增加，对于后者，至少在某些患者中存在改进的选择。一般来说，由单丝制成的大孔网片比小孔网片表面积更小，造成的瘢痕形成和炎症更少，从而降低瘢痕收缩率、疼痛程度以及从瘢痕床取出网片的难度。将网片放置在腹腔时，聚丙烯的额外表面涂层应可防止网片与肠道之间形成瘘管。复发风险主要取决于重叠程度；然而，一些网片的柔韧性可能会增加某些植入操作的技术难度。在伤口发生细菌污染的情况下，迟发性网片感染的风险会增加，单丝网状材料是通过保守方法实现完全愈合的最佳选择。除手术创伤的后果外，尚未在实验和临床研究中证实材料会导致精索功能受损。网片部位的翻修始终是一项手术挑战，但对于在计算机断层扫描（CT）或磁共振成像（MRI）扫描中可见的植入物而言，手术可能会容易得多。
