摘要
目的:探讨开放人工材料桥接修复手术治疗腹壁巨大缺损的应用。方法:回顾性分析2007年6月至2020年6月我科收治的58例腹壁巨大缺损病人临床资料,其中19例腹壁占位性病变切除后缺损,35例巨大切口疝,3例腹壁外伤、感染后肌层毁损,1例先天性膈疝修补后腹腔容积不足延迟关腹,随访观察疗效。结果:本研究所有病人均达到预期重建效果。术后发生血清肿5例,通过重置双套管负压抽吸治愈。皮肤坏死、切口裂开、补片外露1例,用负压封闭引流(vacuum sealing drainage,VSD)技术引流愈合。血肿1例,加压包扎保守治疗。补片感染1例,取出上层补片,应用VSD技术引流愈合。1例腹腔容积不足采用腹腔内修补(intraperitoneal onlay mesh,IPOM)+Inlay桥接、补片外露的临时性关腹,通过3次VSD分期拉拢、关闭皮肤伤口。1例补片膨出,持续随访,未行特殊处理。随访12~156个月,3例失访,随访率为94.8%,未见疝或缺损复发。结论:对于肌筋膜层无法关闭的腹壁巨大缺损,开放人工材料桥接修补手术是腹壁外科不可或缺的一项技术,并发症可以防控。
Objective To analyze the clinical application of open bridging repair with artificial material in treating large abdominal wall defect.Methods A retrospective analysis was performed for 58 patients with large abdominal wall de-fect from June 2007 to June 2020 in our department,including 19 cases of defect after resection of abdominal space-occu-pying lesions,35 cases of giant incision hernia,3 cases of local deficient abdominal wall after abdominal trauma or infec-tion,and 1 case of delayed abdominal closure after congenital diaphragmatic hernia repair due to insufficient abdominal volume.Therapeutic effect was followed up.Results The reconstruction was achieved in all cases.Postoperative complica-tion was found seroma in 5 cases cured with double tubes negative drainage.One case had both skin necrosis and incision dehiscence treated with vacuum sealing drainage(VSD).There was 1 case with hematoma treated by pressure dressing and 1 case with mesh infection treated by upper mesh removal and VSD later.One case had temporary abdominal closure and planned mesh exposure due to insufficient abdominal volume using bridging repair of intraperitoneal onlay mesh and Inlay,who was treated VSD 3 times and staged abdominal closure.Mesh bulging was in 1 case treated with follow-up and obser-vation.Duration of follow-up ranged from 12 to 156 months,with 94.8%follow-up rate and 3 cases lost.No recurrence of hernia or defect was present.Conclusions Open bridging repair with artificial material can be an indispensable skill for large abdominal defects which can not be closed and the complication can be treated.
作者
周静瑜
任峰
周建平
ZHOU Jingyu;REN Feng;ZHOU Jianping(Department of Geriatrics Surgery,The Second Xiangya Hospital of Central South University,Changsha 410011,China)
出处
《外科理论与实践》
2021年第5期420-424,共5页
Journal of Surgery Concepts & Practice
关键词
开放桥接修补
人工材料
腹壁巨大缺损
腹壁重建
并发症
Open bridging repair
Artificial material
Large abdominal defect
Reconstruction of abdominal wall
Complication
