摘要
现代腹壁疝修复已发展为以“腹壁功能重建”为目标的系统工程,其成功极大依赖于自体组织重建与补片加强的深度协同。其中自体组织重建作为修复基础,通过精细解剖学复位、张力控制技术(如组织结构分离、腹横肌松解)及神经血管保护,以自身腹壁各层组织恢复腹壁的完整性,从而为补片加强创造理想的腹壁条件。而补片材料的选择则需遵循个体化原则:清洁手术首选大网孔轻量聚丙烯以实现力学支撑与生物相容性平衡;污染或感染环境下,生物补片凭借其一定的抗感染特性与再生潜能成为此类患者的最优选择;巨大缺损修复需结合组织分离技术与复合补片策略以平衡力学需求与生物学感染风险。良好的修补方案制定应综合考量患者因素(合并症、年龄)、特征(缺损大小、污染程度、腹壁条件)及手术方式(补片放置层次),实现解剖结构、力学传递与生理功能的协同恢复,最终总体提升患者的长期预后水平。
Modern abdominal wall hernia repair has evolved into a systematic engineering project aimed at"functional abdominal wall reconstruction",the success of which largely depends on the deep integration of autologous tissue reconstruction and mesh reinforcement.As the foundation of repair,autologous tissue reconstruction involves meticulous anatomical restoration,tension-control techniques(e.g.,component separation technique,transversus abdominis release),and neurovascular protection to restore the integrity of the abdominal wall's layered structures,thereby creating optimal conditions for mesh reinforcement.The selection of mesh materials should follow individualized principles:large-pore lightweight polypropylene mesh is preferred in clean surgeries to achieve a balance between mechanical support and biocompatibility;in contaminated or infected environments,biological meshes,owing to their inherent anti-infection properties and regenerative potential,become the optimal choice for such patients;and for massive defects,a combination of tissue separation techniques and composite mesh strategies is required to balance mechanical demands and biological infection risks.A well-designed repair plan should comprehensively consider patient factors(comorbidities,age),characteristics(size of defect,contamination level,abdominal wall condition),and surgical approach(mesh placement layer),achieving synergistic restoration of anatomical structure,mechanical force distribution,and physiological function,ultimately improving long-term patient outcomes.
作者
唐健雄
李绍杰
李绍春
Tang Jianxiong;Li Shaojie;Li Shaochun(Department of General Surgery,Huadong Hospital,Fudan University,Shanghai 200040,China)
出处
《中华普通外科杂志》
北大核心
2025年第9期673-676,共4页
Chinese Journal of General Surgery
关键词
疝
腹
疝修补术
组织重建
补片修补
合成补片
生物补片
Hernia,ventral
Herniorrhaphy
Tissue reconstruction
Mesh repair
Synthetic mesh
Biological mesh
