腹壁重建修复手术现状和技术创新

Current status and technical innovation of abdominal wall reconstruction and repair surgery

腹壁缺损以其复杂性和多样性的特点,一直是腹壁外科领域的主要研究方向。我国疝与腹壁外科领域经过20年的快速发展,已经取得了令人瞩目的成绩,从临床上技术上看已经位于国际领先水平。因此,系统总结我国业已开展的卓有成效的工作,思考今后的创新性发展,非常必要。一个理想的重建修复手术不仅可以恢复腹壁自身的重要功能,还能提供足够强度的力学支撑和顺应性,随着腹腔"领地(Domain)"的重建和腹腔内脏器的复位,最终达到腹壁结构-功能的统一。目前,疝与腹壁外科的共识是:由于病人的自身因素、医生对临床技术的经验积累,以及材料科学的快速进步等诸多原因,使得腹壁修复重建仍然面临诸多手术的疑点和难点。虽然近年来各种手术方式层出不穷,但都不能称为一个近乎完美的临床技术,同时也缺乏大宗的临床数据支持。作为腹壁外科医生,建议对于今后的工作有一个可考虑的发展目标、开展基础研究、技术创新,以及行规的制定,是今后重点工作,对于提高中国腹壁缺损的重建修复水平具有重要意义。

Abdominal wall defects have always been the main research direction in the field of abdominal wall surgery due to their complexity and diversity.After 20 years of rapid development in the field of hernia and abdominal wall surgery in China,it has achieved remarkable results in the international arena,and has reached the world’s advanced level in terms of clinical technology.Therefore,it is very necessary to make a systematic summary of the fruitful work that has been carried out in our country,and to think about the innovative development in the future.An ideal reconstruction surgery can not only restore the important functions of the abdominal wall itself,but also provide mechanical support and compliance with sufficient strength.With the reconstruction of the"Domain"of the abdominal cavity and the reduction of the internal organs of the abdominal cavity,the ultimate goal is to unify the structure and function of the abdominal wall.The current consensus of hernia and abdominal wall surgery is that due to the patient’s own factors,the accumulation of experience in clinical technology,and the rapid progress of material science,the repair and reconstruction of the abdominal wall still faces many doubts and difficulties in surgery.Although various surgical methods have appeared in recent years,none of them can be called a nearly perfect clinical technique,and there is also a lack of large clinical data to support it.As an abdominal wall surgeon,it is recommended to have a development plan that can be considered for future work,to carry out basic research,technological innovation,and the formulation of regulations.They are the key tasks in the future.They are of great significance for improving the level of reconstruction and repair of abdominal wall defects in China.