网状增强疝修补术是腹壁和食管裂孔/膈疝管理的金标准,是普通外科医生最常见的手术之一。然而,它伴随着一系列的弊端,包括复发,网状感染,和粘附形成。为了解决这些弱点,已经研究了许多生物材料用于网状涂层。富血小板血浆(PRP)是通过多种细胞因子和生长因子促进组织愈合的自体药剂。此外,许多报告强调了它对更好地集成不同类型的涂层网格的贡献,与传统的无涂层网格相比。文献中已经报道了使用PRP涂层网状物进行疝修补术。但是缺少对技术方面和结果的审查。这篇综合综述的目的是报告研究PRP和网状植入物在疝气动物模型中的协同使用的实验研究。在PubMed/Medline进行了全面的文献检索,WebofScience,和Scopus没有时间顺序限制。总的来说,已包括14项实验研究和3项临床研究。在实验试验中,合成,生物学,复合网格被用在四个,九,和一项研究,分别。在合成网格中,PRP涂层导致增加的抗氧化剂水平和拼贴沉积,减少氧化应激,和改善炎症反应,虽然对生物网格的研究表明,新血管形成和组织整合增加,减少炎症,粘连严重程度,和机械故障率。最后,复合网的PRP涂层导致粘附性降低和机械强度提高。尽管有丰富的临床前数据,缺乏临床研究,主要是由于缺乏有关PRP制备和应用的既定方案。到了这个时间点,PRP已被用作修复腹部和膈疝的涂层剂,以及网片固定。从实验研究中得出的结论的临床应用可能会改善疝修补术的效果。
Mesh-augmented hernia repair is the gold standard in abdominal wall and hiatal/diaphragmatic hernia management and ranks among the most common procedures performed by general surgeons. However, it is associated with a series of drawbacks, including recurrence, mesh infection, and adhesion formation. To address these weaknesses, numerous biomaterials have been investigated for mesh coating. Platelet-rich plasma (PRP) is an autologous agent that promotes tissue healing through numerous cytokines and growth factors. In addition, many reports highlight its contribution to better integration of different types of coated meshes, compared to conventional uncoated meshes. The use of PRP-coated meshes for hernia repair has been reported in the literature, but a review of technical aspects and outcomes is missing. The aim of this comprehensive review is to report the experimental studies investigating the synergistic use of PRP and mesh implants in hernia animal models. A comprehensive literature search was conducted across PubMed/Medline, Web of Science, and Scopus without chronological constraints. In total, fourteen experimental and three clinical studies have been included. Among experimental trials, synthetic, biologic, and composite meshes were used in four, nine, and one study, respectively. In synthetic meshes, PRP-coating leads to increased antioxidant levels and collaged deposition, reduced oxidative stress, and improved inflammatory response, while studies on biological meshes revealed increased neovascularization and tissue integration, reduced inflammation, adhesion severity, and mechanical failure rates. Finally, PRP-coating of composite meshes results in reduced adhesions and improved mechanical strength. Despite the abundance of preclinical data, there is a scarcity of clinical studies, mainly due to the absence of an established protocol regarding PRP preparation and application. To this point in time, PRP has been used as a coating agent for the repair of abdominal and diaphragmatic hernias, as well as for mesh fixation. Clinical application of conclusions drawn from experimental studies may lead to improved results in hernia repair.