主动减容技术在肥胖患者巨大腹壁切口疝修补术中的应用

Initiative volume reduction surgery performed in huge ventral incisional hernia of obese patients

目的探索应用主动减容技术对肥胖患者巨大腹壁切口疝修补的可行性和安全性。方法回顾性分析2011年1月至2013年1月,首都医科大学附属北京朝阳医院对26例巨大腹壁切口疝肥胖患者运用主动减容技术,并用脱细胞组织基质材料生物补片行切口疝修补。结果 26例患者均顺利完成手术,平均手术时间（121±18）min;术中平均出血量（65±28）ml;术中切除腹腔内肠管长度150～350 cm,平均（213±38）cm。术后1周平均腹腔内压力（7.8±2.1）mm Hg,较术前（15.4±1.2）mm Hg明显下降,差异有统计学意义（t=44.879,P〈0.05）。术后平均住院时间（14.2±3.3）d。2例术后切口感染,无吻合口瘘及腹腔脏器损伤。所有患者均获随访,平均随访时间（34±5）个月,1例术后1年复发。术后1年患者BMI为（19.3～25.3）kg/m2,平均（22.5±2.1）kg/m2,较术前（31.8±1.2）kg/m2明显下降,差异有统计学意义（t=39.084,P〈0.05）。结论应用主动减容技术对巨大腹壁切口疝的肥胖患者行修补术可以降低术后腹腔内压力,并避免腹腔间隙综合征的发生,降低肥胖患者体重指数,从而降低术后并发症发生率及复发率。

Objective To discuss the feasibility and safety in repair of obese patients＇ huge ventral incisional hernia with initiative volume reduction surgery（ IVRS）. Methods From January 2011 to January2013,Beijing Chao-Yang Hospital,Capital Medical University performed initiative volume reduction surgery and hernia repair with acellular biological matrix on 26 obese patients with huge abdominal incisional hernia.Results The procedure was completed in all 26 cases with in a mean operation time of（ 121 ± 18） min.The mean intraoperative blood loss was（ 65 ± 28） ml. The mean of（ 213 ± 38） cm length of intestine was resected. Intra-abdominal pressure（ IAH） during the first week after surgery was monitored; the mean pressure was（ 7. 8 ± 2. 1） mm Hg,which was significantly lower than that before operation（ 15. 4 ± 1. 2）.After the operation,the patients were discharged from our hospital in 9 to 20 days with a mean of（ 14 ±3） days. Two of the patients had postoperative wound infection but without anastomotic leak and abdominal organ injuries. All the patients were followed up for（ 34 ± 5） months（ range 12 to 48 months）,and a case of recurrence occurred. The obese patients＇ body mass index（ BMI） fell to 19. 3-25. 3 kg / m2. Conclusions IVRS is safe and effective for obese patients＇ huge ventral incisional hernia associated with loss of abdominal domain. It can reduce postoperative IAH and BMI,and to avoid the occurrence of abdominal compartment syndrome,which finally can reduce the rate of postoperative complications and recurrence.