腹壁子宫内膜异位症手术创面的修复

Repair of abdominal wall defect after resection of abdominal wall endometriosis

目的探讨腹壁子宫内膜异位(AWE)手术中腹壁筋膜层缺损的修复方法。方法回顾性分析55例腹壁子宫内膜异位症患者的病例资料。将55例患者分为两组:(1)腹壁筋膜层缺损组,29例,术中腹壁筋膜缺损面积超过2 cm2;腹壁筋膜缺损组根据腹壁筋膜层缺损面积(由小到大)处理如下:11例患者常规缝合腹壁;7例患者应用张力线、PDS-Ⅱ或筋膜／皮肤减张缝合重建腹壁; 4例手术中应用筋膜补片;7例腹壁筋膜层和皮肤缺损大的患者由整形科协助应用腹壁成形术和筋膜补片。(2)无腹壁筋膜层缺损组,26例,术中腹壁筋膜缺损面积小于2 cm2。无腹壁筋膜层缺损组常规缝合腹壁。结果所有患者切口Ⅰ期愈合。腹壁筋膜缺损组术前B超测量和切除AWE的最大径线、所需手术时间和出血量显著大于无筋膜缺损组,差异有统计学意义。两组各有1例病情复发。结论B超检查有助于术前准确评估病灶情况。腹壁缺损大于2 cm2时可采用筋膜／皮肤减张缝合进行修复,更大者可采用筋膜补片／腹壁成形术进行修复。

Objective To study the techniques to repair the fascia layer of abdominal wall after the resection of abdominal wall endometriosis （ AWE ） . Methods Fifty-five AWE patients aged 28 ～ 38 underwent resection of the lesion. After the resection a defect fascia in abdominal wall larger than 2 cm^2 was seen in 29 patients （ large fascia defect group）, and in the other 26 patients the fascia defect was less than 2 cm^2（ small fascia defect group）. In the large fascia defect group, 11 cases underwent routine closure of the abdominal wall, 2 underwent abdominal wall reconstruction by applying tension suture, 1 case underwent fascia layer/skin tension-relieving suture, 4 cases abdominal wall reconstruction by PDS- Ⅱ suture, 4 cases underwent fascia patch grafting, and 7 cases underwent abdominal wall plastic repair plus fascia patch grafting, the different techniques being selected according to the size of the defect. Routine abdominal wall closure was performed on all the 26 patients in the small fascia detect group. The features of the lesion and operation, and the outcomes were compared, Results Primary healing was achieved in all the patients, In comparison with the small fascia defect group, the mean size of the masses measured by pre-operational uhrasonography of the large fascia defect group was significantly bigger [ （ 3. 8± 1. 4 ） cm vs. （ 2. 5 ± 1.1 cm） ] , the mean size of the masses resected in operation was significantly larger [ （5.5 ±2. 0） cm vs. （ 3, 7 ± 1, 9） cm, P = 0, 004 ], the operation time was significantly longer [ （ 66 ± 42 ） min vs, （ 35 ± 24 ） min, P =0.002], and the intra-operational blood loss was significantly more [ （52 ±50） ml vs. （23 ± 19） ml, P = 0.006 ], Relapse occurred in 1 case in the large fascia defect group, Conclusion Ultrasonography helps estimate the extension of AWE before operation, Fascia layer/skin tension-relieving suture can be used in the fascia defect of abdominal wall larger than 2 cm^2. Abdominal wall plastic repair plus fascia patch grafting is capable of repairing larger fascia layer and skin defects of abdominal wall.