创伤后计划性腹疝确定性重建的新方法——改良腹直肌推徙术

Huge planned abdominal hernia by modified sliding myofascial flap of rectus abdominis

目的探讨开放腹腔手术后巨大计划性腹疝的新的手术方式改良腹直肌推徙术的治疗效果。方法总结分析12例巨大计划性腹疝患者的临床资料和改良腹直肌推徙术的治疗结果。其中，男9例，女3例，平均41．5岁。术前合并结肠造口5例；回肠造口2例；胰瘘1例；胃空肠吻合口一腹壁瘘1例；慢性胆囊炎1例。计划性腹疝至确定性重建的时间平均为6．5个月。结果本组12例患者手术后救治成功12例（成功率100％），术后发生皮下血清肿1例，皮缘坏死2例，经引流及换药治愈。术后无严重感染并发症，无复发性腹腔间隙综合征发生，无脏器功能障碍发生。腹直肌功能恢复良好，无其他不适症状。随访2～25个月，平均13．6个月，轻度复发1例。结论改良腹直肌推徙术治疗巨大计划性腹疝，方法实用，操作简单，效果良好，为开放腹腔手术后巨大计划性腹疝患者临床治疗提供了新的可供选择的手术方法。

Objective To investigate the proficiency of modified sliding myofascial flap of rectus abdominis to intervene the huge planned hernia post open abdomen. Methods 12 cases, 9 male and 3 female with an average age of 41.5 years old, of which were performed the modified sliding myofascial flap of rectus abdominis to achieve the definitive reconstruction of the abdominal walls were retrospectively reviewed. Among the operation, it came along with 5 cases of colonstomy, 2 cases of ileumstomy, 1 case of pancreatic fistula, 1 case of intestinal fistula, and 1 case of cholecystitis. Results All the 12 patients were cured after operation, however with 1 case of seroma, 2 case of skin marginal necrosis which were treated by drainage and recovered. No other complication was found. The function of rectus abdominis restored. All cases were followed up for a period of between 2 and 25 months with an average of 13.6 months. 1 case was reported as mild re-occurance which was still under a further investigation. Conclusion The methodology of modified sliding myofascial flap of rectus abdominis is considered being a novel, alternative, medical approach for the huge planned hernia patients, which would reach to a hopeful outcome.