应用脱细胞真皮基质材料修补复杂腹壁切口疝

Repair of complex abdominal incisional hernia with aceHular dermal matrix

目的探讨脱细胞真皮基质材料对复杂的腹壁切口疝的修复治疗效果。方法回顾性分析2008年1月至2010年6月问使用脱细胞真皮基质（acellular dermal matrix，ADM）材料修补的7例复杂的腹壁切口疝的治疗方法。其中男4例，女3例，年龄43～83岁，中位年龄53岁；7例中有2例伴有腹股沟斜疝，给予同时修补；5例同时进行了胃肠道手术，其中有2例伴有小肠瘘；疝环直径为9．2～16．5cm，平均（11．6±2．8）cm；5例使用腹腔内修补（intraperitoneal onlay mesh，IPOM），2例为腹膜外修补（total extraperitoneal prothesis，TEP）。结果本组患者均手术顺利，放置ADM补片至关腹结束的平均手术时间（33±12）min；术中平均出血量（16±4）ml；住院时间7～12d。所有使用ADM的患者均痊愈出院，术后未发现有慢性疼痛、感觉异常、肺炎、尿路感染等并发症，手术切口无红肿、溃破、无血清肿。7例均获随访，随访时间5～26个月，中位随访时间为14个月，随访期间未发现浅部感染或深部感染，无疝复发。结论脱细胞真皮基质材料作为一种新的生物补片，适用于复杂腹壁切口疝，尤其是伴有污染的腹壁切口疝的修补。

Objective To evaluate the repair of abdominal complicated incisional hernia using acellular dermal matrix （ ADM ）. Methods Retrospective analysis was made on 7 cases with abdominal complicated incisional hernia treated by ADM in our hospital from January 2008 to June 2010, among them there were 4 males and 3 females. Age ranged from 43 to 83 years and the median age was 53 years. Two concurrent indirect inguinal hernia cases were repaired and concurrent gastrointestinal tract problems including 2 small bowd fistulas were operated one stage in 5 cases. Mean diameter of hernia ring was （ 11.6 ± 2. 8 ） cm, ranged from 9. 2 to 16. 5 em. 5 cases were repaired by using intraperitoneal onlay mesh, others using total extraperitoneal prothesis. Results All patients were operated on successfully. Average time was （33 ± 12） min. Blood loss was （16±4） ml. Hospital stay was 7 - 12 d. 7 patients repaired by ADM fully recovered. There were no chronic pain, paresthesia, pneumonia and urinary tract infection cases, no incision swelling, seroma or infection. All patients were followed up with median time of 14 months, ranging from 5 to 26 months. There were not hernia recurrence, nor surgical site infection during follow-up period. Conclusions For the repairing of abdominal complicated incisional hernia, the application of aeellular dermal matrix is safe and effective method especially in those of ineisional hernia complicated by infection.