巨大切口疝的开放式无张力修补术

Open tension-free repair with prosthetic mesh for giant incisional abdominal hernia

目的:总结无张力技术修补巨大切口疝的临床经验及其围手术期处理要点。方法:对我院2002年5月至2007年5月收治的38例巨大切口疝临床资料进行回顾性分析,其中30例应用肌后修补法(sublay法)修补,8例采用腹腔内补片修补法(underlay法)修补,所用补片材料为聚丙烯(68.0%)或复合补片(32%)。随访1～5年,统计病人的并发症和复发率。结果:80%病人有术前合并症,包括肥胖(45%)、糖尿病(16.4%)、慢性阻塞性肺疾病(12.5%)和腹主动脉瘤(2.7%)。无张力疝修补后2～3周病人均痊愈出院。随访结果,复发2例(5.3%),伤口感染3例(7.9%),血清肿5例(13.1%)。结论:人工材料无张力修补术是治疗腹壁大切口疝的优良术式,手术创伤小、术后恢复快。对于疝环巨大或疝内容物多、突出时间长的特大切口疝病人应给予充分的术前准备。

Objective To summarize the clinical experience of the tension-free technique in abdominal giant incisional hernia （AGIH） repair, and its perioperative management. Methods During the period from May 2002 to May 2007, 73 patients underwent prosthetic mesh repair for abdominal incisional hernia; among which, 30 cases underwent sublay repair and 8 cases underwent underlay repair. Polypropylene meshes were used in 68% of the cases and compound meshes in 32%. Results Eighty percent of the patients had concomitant diseases before the operation, including obesity （45%）, diabetes （16.4%）, chronic obstructive pulmonary diseases （12.5%）, and abdominal aneurysm （2.7%）. The follow-up duration ranged from 1 to 5 years. The most common postoperative complications were seroma （12.3%） and wound infection （7.9%）. The average postoperative hospital stay was 10 days. Two hernia recurrences were observed. Conclusions Application of a prosthetic mesh is a safe and effective method in AGIH repair, leading to minimal invasion and quick recovery. Sufficient preoperative management is of the prime importance for patients with large hernia ring or prolonged hernial prolapse.