腹直肌及前鞘缺损的手术修复方式

Reconstuctive strategy of the defect of anterior rectus fascia and rectus abdominus muscle

目的探讨临床腹直肌及前鞘缺损的手术修复方式。方法2009年11月至2020年1月,北京大学人民医院医疗美容科对腹直肌及前鞘缺损女性患者24例29侧缺损进行修复,年龄35~60岁,平均44岁。根据腹直肌和前鞘缺损大小及位置分为直接缝合修复和聚丙烯补片修复。结果24例患者伤口均一期愈合,未发生伤口感染、血肿、裂开等并发症。随访5~126个月,平均66.6个月;1例患者术后36个月因乳腺癌转移死亡,1例患者腹部膨隆,无不适未采取措施;22例未发生感染、排异等不良反应。结论根据腹直肌及前鞘缺损的大小及位置用不同的修复方法,重建腹壁结构的完整性及稳定性。

Objective To discuss the reconstuctive strategy of the defect of anterior rectus fascia and rectus abdominus muscle in the clinical practice.Methods Between November 2009 and Janurary 2020,clinical data of 24 female patients that underwent 29 anterior rectus fascia and rectus abdominus muscle reconstructions of defect were reviewed retrospectively.The median age was 42.5 years(range,35-60 years),including 20 breast reconstructions,2 pelvic reconstructions,1 thoracic defect after tumor resection and 1 abdominal defect after tumor resection.According to the location and size of the anterior rectus fascia and rectus abdominus muscle defect,three reconstructive methods were applied:6 direct clousres were applied if the width of defect was less than half of the anterior rectus fascia,21 polypropylene mesh onlay reconstructions were applied for which the width of defect was or more than half of the anterior rectus fascia,and 2 direct suture closure were applied for the simple rectus abdominus muscle defect.Results All the patients healed eventfully without abdominal wound complications,such as infection,hematoma,dehiscence.The patients were followed up for a median period of 30 months(range,5-126 months).1 patient died of breast cancer recurrence and matastasis at 36 months postoperatively.No patient developed a mesh infection or required mesh removal secondary to infection or foreign body reaction.There was no abdominal wall hernia,1 patient developed abdominal bulge without further treatment because of no abdominal wall discomfort.Conclusions The key of successful operation is different reconstructive methods applied to reconstruct the integrity and stability of abdominal wall,based on the location and size of the anterior rectus fascia and rectus abdominus muscle defect.