巨大腹壁切口疝24例围手术期处理分析

Perioperative management of huge abdominal incisional hernia:a report of 24 cases.

目的 探讨巨大腹壁切口疝的临床特点及围手术期的处理经验。方法 分析 2 0 0 1年 5月至 2 0 0 3年7月南京军区南京总医院收治的 2 4例巨大腹壁切口疝病人的临床资料。结果 2 4例中 12例有明显的腹内压增高病因 ,2 4例均使用人工合成高分子材料修补 ,术后腹带加压包扎 2周 ,预防性使用抗生素 ,引流积液和血液 ,引流管多在 3～ 5d拔除。术后经鼻导管给氧 4例 ,经面罩给氧 6例 ,气管插管接呼吸机正压辅助呼吸 11例。结论 腹壁巨大切口疝应加强围手术期处理 ,尤其是呼吸功能的监测和维护 ,以确保手术的安全。

Objective To explore the perioperative management and the characteristics of huge abdominal incisional hernia. Methods Twenty-four patients with huge incisional hernia of abdominal wall treated from May 2001 to July 2003 in Nanjing General Hospital of Nanjing Command of PLA were analyzed retrospectively. Results Among the 24 patients, evident increase of intraabdominal pressure occurred in 12 cases. All patients were operated with application of man made material in surgical repair of abdominal incisional hernia. It is identical important for pressure dressings of abdomen,the use of preventive antibiotics and drainage of accumulative blood and fluid from incision were performed for two weeks and draining ducts were extracted during 3-5 days. Four cases breathed in oxygen from nasal duct after operation. Six cases breathed in oxygen from face masks and 11 cases breathed through tracheal intubation ventilator in postoperation. Conclusion The danger of huge incisional hernia may be significantly decreased by preventing and curing the complications, monitoring the respiratory function and using assistant ventilator which can improve respiration in the perioperative period.