异种硬脑膜替代物移植的研究进展

学术背景：目前用于硬脑膜修复的材料有着许多的不足。因此研制更为理想的硬脑膜替代物仍十分必要。目的；介绍异种硬脑膜移植的最新研究及应用进展，指导进一步开展异种硬脑膜方面的研究。检索策略：应用计算机检索PubMed数据库和万方数据知识服务平台1993-01／2008-01的相关文献，检索词为“dura mater，dural substitute，dural graft，sterilization，Biomedical Materials；硬脑膜，硬脑膜替代物，硬脑膜移植，灭菌，生物材料”，限定文章语言分别为英语和中文。检索到文献321篇，其中英文221篇，中文100篇，对文献进行筛选，纳入标准：①选取针对性强，相关度高的文献。②对同一领域的文献选择近期发表或权威杂志的文献；排除重复研究和Meta分析类文章。文献评价：选用33篇文献，其中1篇为综述、其余均为临床与实验研究。资料综合：从与异种移植密切相关的感染、术后修复及免疫原性3个重要问题对替代物灭菌及保存的方法、术后排斥反应及修复机制的最新研究加以综述。目前用于异种硬脑膜替代物灭菌的方法有；戊二醛浸泡法、过氧乙酸-乙醇浸泡法、环氧乙烷熏蒸法及辐照法；用于保存硬脑膜替代物的方法主要有冷冻干燥法和深低温冷冻法。硬脑膜主要表达MHC—Ⅰ类抗原，抗原主要位于含量甚少的内皮细胞和血管内皮上，是一种弱抗原物质，且异种硬脑膜移植属于结构移植，术后很少出现排斥反应。成纤维细胞是硬脑膜修复的主要细胞，它的逸出、增殖是硬脑膜缺损修复的重要机制。结论：异种硬脑膜替代物因其组织相容性好、术后感染发生率低、来源丰富、价格低廉等优点，具有广泛的临床应用前景。

Research advances in xenogeneous dura mater substitute

BACKGROUND： The application of current materials used to repair cerebral dura mater is limited by their disadvantages. Therefore it is necessary to exploit ideal dural substitute. OBJECTIVE： To introduce the latest research and development of dural xenogeneous graft to guide the further related study. RETRIEVAL STRATEGY： The relevant articles published in English and Chinese between January 1993 and January 2008 were retrieved from PubMed and service platform of Wanfang Database using the keywords ＂dura mater, dural substitute, dural graft, sterilization, Biomedical Materials＂ in English and Chinese. 321 literatures were retrieved, including 221 English, and 100 Chinese. Articles 1.closely related to objective and 2.published recently or in the authoritative journals were included. Repetitive articles and Meta analysis articles were excluded. LITERATURE EVALUATION： Of the 33 included articles, 1 was review article, and the others were clinical and experimental studies. DATA SYNTHESlS： The methods of substitute sterilization and preservation, the latest research of reject reaction and repair mechanism were reviewed based on the three problems that closely related to xenogeneous grafting which are infection, postoperative repair, and immunogenicity, Current substitute sterilization methods of dural xenogeneic graft include glutaraldehyde soaking method, peroxyacetic acid-alcohol soaking method, ethylene oxide fumigation, and irradiance. The preservation methods refer to lyopyilization and cryopreservation. Dura mater mainly expresses MHC- Ⅰ antigen, as a kind of weak antigen, located at endothelial cells and blood vessel endothelium. Dural xenogeneous grafting is structural grafting, so reject reactions after operation are few. Fibroblasts are important functioning cells during dural repairing. The mechanism of dural defect repair is related to fibroblast outgrow from dura mater injured margin and proliferation. CONCLUSION： Dural xenogeneous substitutes have good histocompatibility, low incidence