腹壁疝补片修补术后感染的外科处理

Surgical Treatment for Mesh Infection after Prosthetic Patch Repair of Ventral Hernia

目的总结腹壁疝补片修补术后感染的外科处理方法及经验。方法回顾性分析我科2007年6月至2010年5月期间16例腹壁疝补片修补术后感染并接受外科处理的患者的临床资料,其中男10例,女6例;年龄24～73岁,平均45.2岁。其中腹壁切口疝补片修补术后感染11例,腹壁肿瘤切除术后腹壁缺损补片修补术后感染4例,回肠代膀胱造口旁疝补片修补术后感染并尿瘘1例。患者表现有补片暴露、慢性流脓、腹壁慢性窦道及肠皮瘘,均就诊于初次手术的医生,经局部换药处理后3～24个月未愈。患者在我科接受了根治性感染网片切除及腹壁重建术。结果所有患者均将感染补片取出,5例采用成分分离技术自体组织游离修补,4例同时应用聚丙烯平片加强修补,5例同时行脱细胞基质生物补片修补,1例未行修补给予切口创面负压吸引加局部换药,1例去除补片后未行加强修补直接缝合关闭切口。术后住院时间9～25d,平均14d。术后切口一期愈合13例,其余3例切口经局部换药二期愈合。随访6～34个月,平均22个月,无疝复发。结论腹壁疝或缺损补片修补术后感染的外科处理非常棘手,需根据患者个体具体情况处理方可取得满意效果。

Objective To summarize the method and experience in surgical treatment for mesh infection after prosthetic patch repair of ventral hernia. Methods The clinical data of 16 patients with mesh infection after ventral hernia repair accepted surgical treatment in our department from June 2007 to May 2010 were analyzed retrospectively.There were 10 males and 6 females,the age range from 24 to 73 years with an average 45.2 years.The patients with mesh infection included 11 cases of infection after incisional hernia repair,4 cases of infection after abdominal wall defects repair caused by abdominal wall tumor resection,1 mesh infection combine with urinary fistula caused by parastomal hernia of ileal neobladder repaired by using prosthetic patch.Clinical manifestation included mesh exposion,abscess,chronic sinus,and enterocutaneous fistula.All patients accepted local treatment of change dressing by primary operative surgeon,but the wounds didn’t heal about 3 to 24 months.Then the patients performed radical removal of infected mesh and abdominal wall reconstruction. Results All patients accepted affected mesh removal successfully.Five patients performed abdominal wall reconstruction by using components separation technique.Four cases accepted abdominal wall repair by using polypropylene mesh.Five patients performed abdominal wall repair by using human acelluar dermal matrix.One case accepted change dressing and vacuum aspiration on the infected wound surface without reconstruction.And one case closed the wound immediately after infected mesh removal.The postoperative hospitalization time was 9 to 25 d（average 14 d）.Thirteen patients recovered with primary wound healing.The other 3 cases recovered with second healing by local change dressing.All patients were followed up from 6 to 34 months（average 22 months）,no abdominal wall hernia recurrence occurred. Conclusions It is very difficult to deal with mesh infection after prosthetic patch repair of abdominal wall hernia or defect.The surgical treatment should be done according to specific condition of each individual so as to acquire satisfied results