CT在巨大切口疝患者疝修补术前渐进性气腹中的应用

Application of abdominal computerized tomography in preoperative progressive pneumoperitoneum before hernia repair in patients with large incisional hernia

目的探讨腹部CT在指导巨大切口疝患者行疝修补术前渐进性人工气腹(preoperative progressive pneumoperitoneum,PPP)治疗中的价值。方法选取2011年1月至2014年1月,湖北省枣阳市第一人民医院就诊的巨大切口疝患者10例进行回顾性分析。所有患者均接受腹部64排螺旋CT检查,通过CT影像确定疝囊与腹腔的上下、左右与前后径,按椭圆体体积公式计算疝囊与腹腔体积,并计算疝囊/腹腔体积比。将疝囊/腹腔体积比>25%的6例患者行疝修补术前PPP治疗,随后接受传统疝修补术。结果术后共随访3年,10例患者中出现切口感染1例,切口疝复发1例,死亡1例,死因为慢性阻塞性肺疾病并发的呼吸衰竭。所有患者均未出现PPP导管相关并发症和腹腔内压增高相关并发症。结论腹部CT在巨大切口疝的外科治疗中能提供有效的辅助作用,可准确的提供疝囊与腹腔体积的计算依据,为疝修补术前PPP治疗提供客观依据。

Objective To investigate the applicability of abdominal computerized tomography（ACT） in preoperative progressive pneumoperitoneum（PPP） before hernia repair. Method We enrolled 10 patients suffered large incisional hernia in the First People’s Hospital of Zaoyang from January 2011 to January 2014. The patients were all received abdominal CT examination. The upper/cranial, lower/caudal and anteroposterior diameters were measured via CT images, then the volumes of hernia and abdomen were calculated according to formula for the volume of an ellipsoid, and the hernia/abdomen volume ratio was calculated. In total, there were 6 patients whose hernia/abdomen volume ratio 〉25% received PPP treatment before hernia repair. Results In the 3-years follow-up, there were 1 wound infection, 1 hernia recurrence and 1 death due to lung failure. There were no complications related to PPP catheter implantation surgery or high abdominal pressure. Conclusion ACT is a useful tool in the treatment of large incisional hernia.