改良腹直肌推徙术治疗腹腔扩容术后巨大计划性腹疝

Modified sliding rectus abdominus myofascial flap for huge planned abdominal hernia after intra-abdominal volume increment

目的 探讨改良腹直肌推徙术治疗腹腔扩容术后巨大计划性腹疝的效果. 方法 回顾性分析7例巨大计划性腹疝患者的临床资料,其中男4例,女3例;平均年龄43.4岁.合并造口4例,胰瘘1例,肠瘘1例,胆囊炎1例.所有患者均接受改良腹直肌推徙术治疗,行确定性腹壁重建,计划性腹疝至确定性重建的平均时间为6.4个月. 结果 7例均救治成功.平均手术时间180 min,术中平均失血量150 ml.术后发生皮下血清肿1例,皮缘坏死1例,均经引流治愈,无严重感染并发症.无复发性腹腔间隙综合征发生,无脏器功能障碍等发生.腹直肌功能恢复良好,无其他不适症状.随访l ～21个月,平均12.3个月,轻度复发l例,暂时观察中. 结论 改良腹直肌推徙术治疗巨大计划性腹疝,效果良好,为腹腔扩容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 examine the effect of modified sliding myofascial flap of the rectus abdominis to intervene the huge planned hernia following intra-abdominal volume increment.Methods A retrospective review was made on 7 cases （4 males and 3 females at mean age of 43.4 years）.Colostomy or ileumstomy co-occurred in 4 cases,pancreatic fistula in 1,intestinal fistula in 1,cholecystitis in 1.Definite abdominal wall reconstruction was performed using the modified sliding rectus abdominus myofascial flap and mean delay time was 6.4 months.Results Surgical success rate was 100％.Mean operation time was 180 minutes and mean intraoperative blood loss was 150 ml.One case of subcutaneous hematoma and one skin marginal necrosis were noted after operation,but cured later by volume drainage.There were no postoperative complications such as infection,reproductive abdominal compartment syndrome （ACS）,and organ function impairment.Rectus abdominis functioned well without any other symptoms.At the follow-up of 1-21 months （mean,12.3 months）,1 case had mild relapse and kept under temporary observation.Conclusion Modified sliding rectus abdominus myofascial flap is novel and effective treatment choice for huge planned abdominal hernia after intra-abdominal volume increment.