腹腔高压时应用生物材料修补腹壁切口疝（附23例报告）

Repair of ventral hernia with biomaterials in the setting of intra - abdominal hypertension ： report of 23 cases

目的总结腹腔高压时应用生物材料补片修补腹壁切口疝的临床经验。方法回顾分析我院自2004年10月至2008年10月对23例伴有腹腔高压的腹壁切口疝患者应用生物材料补片进行无张力修补手术的临床资料。结果23例中有21例（91．3％）完成一期修补手术成功关腹，2例（8．7％）因腹腔压力过高而放弃疝修补手术，以ePTFE补片行暂时性关腹。手术时间60～160min，平均115min。成功关腹的21例中有1例（4．8％）出现术后腹腔间隔室综合征，经呼吸机辅助呼吸等保守治疗无效，行打开腹腔减压、eFFFE补片暂时性关腹。其余20例顺利出院，住院时间9～18d，平均12．5d。全部患者随访1～5年，1例（4．3％）术后1年复发，因一般情况差而未再行手术治疗，其余22例（95．7％）未见复发。结论腹腔高压时以生物材料进行腹壁疝修补具有其自身的特点，注意围手术期处理及手术技巧是保障手术成功的关键。

Objective To investigate and summarize the clinical experience of repair of ventral hernia with biomaterials in the setting of intra - abdominal hypertension. Methods From Oct. 2004 to Oct. 2008, repair of ventral hernia with biomaterials was applied in 23 patients with intra - abdominal hypertension,whose clinical data were studied retrospectively. Results 21 repair procedures were performed,after which the abdomen were closed successfully. 2 repair procedures were ceased and converted to temperory closing abdomen operation with ePTFE patch because of over intra - abdominal hypertension. The operative time was ranged 60 to 160 min. 1 abdominal compartment syndrome oeeurred postoper- atively and the conservative therapy had no efficiency, so another laparotomy were done to decompress pressure of the abdominal cavity. 20 patients were cured and discharged,with postoperative hospital stay 3 to 7 days. Only 1 recurrence happened during 1 - 5 years followed - up. Conclusion Repair of ventral hernia with biomaterials in the setting of intra - abdominal hypertension was characteristic. Perioperative management and operative technology played the key role in the success of repair procedure.