纺织学报 ›› 2022, Vol. 43 ›› Issue (03): 1-7.doi: 10.13475/j.fzxb.20211109707

• 特约专栏：生物医用纺织品 •    下一篇

用于应对疝修补术后并发症的经编补片研究进展

乔燕莎1,2, 毛迎1,2, 徐丹瑶1,2, 李彦1,2, 李绍杰3, 王璐1,2(), 唐健雄3   

  1. 1.东华大学 纺织学院, 上海 201620
    2.东华大学 纺织面料技术教育部重点实验室, 上海 201620
    3.复旦大学附属华东医院普外科 疝与腹壁外科治疗与培训中心, 上海 200040
  • 收稿日期:2021-11-24 修回日期:2022-01-06 出版日期:2022-03-15 发布日期:2022-03-29
  • 通讯作者: 王璐
  • 作者简介:乔燕莎(1994—),女,博士生。主要研究方向为生物医用疝修补片。
  • 基金资助:
    高等学校学科创新引智计划2.0项目(BP0719035)

Research progress in warp-knitted meshes for tackling complications after hernia repair

QIAO Yansha1,2, MAO Ying1,2, XU Danyao1,2, LI Yan1,2, LI Shaojie3, WANG Lu1,2(), TANG Jianxiong3   

  1. 1. College of Textiles, Donghua University, Shanghai 201620, China
    2. Key Laboratory of Textile Science & Technology, Ministry of Education, Donghua University, Shanghai 201620, China
    3. Hernia and Abdominal Wall Surgery Center, Department of General Surgery, Huadong Hospital of Fudan University, Shanghai 200040, China
  • Received:2021-11-24 Revised:2022-01-06 Published:2022-03-15 Online:2022-03-29
  • Contact: WANG Lu

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摘要：

针对疝修补合成补片植入后带来的多种并发症问题,明确了并发症的诱发因素为病原菌带来的污染和补片本体材料导致的异物反应。以临床常用的经编补片为研究对象,将目前应对疝修补术后并发症的手段分为经编结构调控和表面修饰改性。根据应对场景(有菌性炎症和无菌性炎症)和使用场合(腹腔内和腹腔外)的不同,对表面修饰改性进行了分类阐述。列举了近年来相关研究及临床商用补片取得的成果进展,并将表面改性补片归纳为抗菌型、防粘连型、抗炎型,通过分别概述其相应的作用机制及并发症应对效果,分析了当前3种不同类型表面改性补片存在的问题,并指出具有高附加功能的经编补片将是未来的发展方向。

关键词: 疝补片, 医用纺织品, 经编补片, 疝修补, 并发症, 结构调控, 表面修饰

Abstract:

In view of the multiple complications caused by synthetic meshes implanted for hernia repair, a literature review was carried out and it revealed that the triggering factors of complications are the pollution from the pathogenic bacteria and the foreign body reaction from the mesh. Regarding the commonly used warp-knitted mesh, the present treatments were divided into the warp-knitted structure adjustment and the surface modification. According to the different scenarios (bacterial or aseptic inflammation) and occasions (intraperitoneal or extraperitoneal), the surface modifications were classified and explained. The progress in related researches and clinical commercial meshes in recent years were scrutinized, and summarized three types of modified meshes (anti-bacterial, anti-adhesion, anti-inflammation) were summarised. By outlining the corresponding mechanisms and effects on complications, this paper pointed out the current problems of these types of modified meshes and concluded that the high-value warp-knitted mesh is the future development direction.

Key words: hernia mesh, medical textiles, warp-knitted mesh, hernia repair, complications, structure adjustment, surface modification

中图分类号: 

  • TS159

表1

抗菌经编补片的相关研究"

抗菌剂 负载方法 抗菌效果 参考文献
左氧氟沙星 在PP补片表面构建不同分子质量壳聚糖交联网络,药物同时被笼络进去 中等分子质量的壳聚糖-药物涂层的体外抗SA能力可持续6 d [23]
聚多巴胺黏附 体外抗SA能力持续6 d [24]
在PP补片上接枝的具有疏水腔结构的环糊精装载 体外抗SA能力持续10 d [25]
利福平 热敏型水凝胶负载 体外抗菌活性可持续5 d,在体内阻止感染并促进了良性的组织整合 [26]
经聚(丙交酯-co-乙交酯)(PLGA)微球装载后再通过PLGA涂层热固化在补片表面 体外抗SA能力长达30 d [27]
庆大霉素+利福平 热敏型水凝胶负载 体外抗SA能力持续5 d,抗SE能力至少可达7 d [28]
利福平或氯己定 经PLGA纳米颗粒负载后再通过壳聚糖涂层固定在补片表面 体外对SA和SE均有高度抗杀能力;负载氯己定能持续7 d,负载利福平能持续14 d [29]
羧甲基纤维素水凝胶负载 在SA感染模型中控制了感染并促进了组织修复 [30]
三氯生 在PP补片上接枝的具有疏水腔结构的环糊精装载 体外抗SA能力达11 d [31]
氯己定 羧甲基纤维素水凝胶负载 体外抗SA能力至少3 d,在体内阻止了感染 [32]
合成可降解聚合物负载 体外抗SA能力达7 d [33]
纳米银 射频溅射法 体外抗SA且不影响间皮细胞生长 [34]
以碳酸钙为载体通过电喷法沉积 体内控制了耐甲氧西林金黄色葡萄球菌引发的感染 [35]
纳米金刚石 以壳聚糖表面涂层为载体 体外抗大肠杆菌,无细胞毒性 [36]
纳米金 等离子体活化接枝 抗生物膜形成 [37]
阳离子抗菌肽 和聚己内酯共混后静电纺丝 体外抗大肠杆菌但不抗SA,无细胞毒性 [38]

表2

防粘连经编补片的相关研究"

防粘连材料 构建方法 防粘连效果 参考文献
聚乙烯醇 在等离子体活化的PP表面化学接枝 植入兔腹腔3个月后,仅有边缘粘连,约占补片面积的20%,且容易将组织剥离 [41]
聚多巴胺 氧化沉积 植入大鼠腹腔后的第10天和第60天,Katada黏附评分和商用防粘连补片(Parietex)相当 [42]
氧化羧甲基纤维素-g-多巴胺和羧甲基壳聚糖 2种成分的溶液共混后在补片表面原位形成水凝胶 植入猪腹腔1 a后,涂层补片的粘连面积和强度均显著低于PP [44]
丝素蛋白 丝素蛋白与丙烯酰胺在自由基诱导下形成互穿网络 植入兔腹腔内1个月,粘连评分显著低于PP [45]
聚(乳酸-co-乙醇酸)和壳聚糖 静电纺膜 植入大鼠腹腔7 d后,涂层补片的粘连评分均低于PP [46]
聚己内酯和氧化再生纤维素颗粒 静电纺膜 植入大鼠腹腔7 d后,氧化再生纤维素使涂层补片的粘连评分显著低于PP [47]
丝素蛋白 静电纺膜 植入大鼠腹腔内6周时,无粘连;12周时粘连面积显著低于PP,且黏附力也很低 [48]

表3

抗炎经编补片的相关研究"

抗炎材料 修饰方法 抗炎效果 参考文献
间充质干细胞 用明胶或聚赖氨酸涂覆补片后接种细胞 在体内外均能诱导巨噬细胞向M2极化 [49]
间充质干细胞和外泌体 用固定补片的纤维蛋白胶负载 营造抗炎微环境,促进组织重塑 [50]
脂肪干细胞 细胞接种 降低了大鼠全身炎症反应 [51]
壳聚糖和明胶 补片在共混溶液中浸没后加入交联剂整体复合成形 下调促炎因子和上调抗炎因子,但基质沉积量增加 [52]
胶原蛋白 补片在共混溶液中浸没后整体固化成形 上调促炎因子表达,引发了更强的炎症 [53]
胶原蛋白和磷酸盐 补片在共混溶液中浸涂后交联成形 降低了局部炎症和促进了组织整合 [54]
硫酸软骨素和明胶 补片在共混溶液中浸涂后交联定形 降低了局部炎症和纤维化 [55]
磷酰胆碱基聚合物 表面金属酚醛网络接枝 降低了局部炎症和纤维化 [56]
甲基丙烯酸 溶液喷涂 降低了炎症和促进了血管化 [57]
S-亚硝基谷胱甘肽 聚乙烯醇涂层负载 炎症程度减弱,血管生成增加 [58]
类固醇 植入前浸渍在药物溶液中 炎症程度降低 [59]
维生素E 溶液浸渍 炎性反应减弱,纤维化程度较低 [60]
白细胞介素4 层层自组装 形成抗炎微环境,降低了纤维化,改善了组织整合 [61]
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