创伤性腹壁疝:致伤机制及治疗策略

Traumatic abdominal wall hernia:injury mechanisms and treatment strategies

腹部钝性伤后腹壁筋膜肌层断裂或撕裂而皮肤完整即可发生创伤性腹壁疝(traumatic abdominal wall hernia,TAWH),多数为机动车交通事故所致,与使用安全带有关。临床医师对其认识不足,也无高质量的循证医学证据指导临床救治。CT的应用显著提高了TAWH的诊断水平,且可精确评估是否有腹腔内脏器损伤。对于不需要紧急剖腹的患者,越来越多的证据支持采用延迟手术的治疗策略,便于使用补片以降低复发率。本文回顾近年来文献进展,阐述TAWH的致伤机制、分类和诊治进展。

Traumatic abdominal wall hernia(TAWH)can occur after blunt abdominal injuries with rupture or tear of the fascial myolayer of the abdominal wall but skin integrity.It is often caused by motor vehicle accidents,with the use of seat belts.Recognition of TAWH is far from enough among clinicians right now and there are no high-quality evidence-based studies to guide its clinical management.This study reviews the recent literature.It is found that the use of CT has significantly improved the diagnostic level of TAWH,and moreover CT can accurately determine the existence of intra-abdominal organ injuries.For patients who require no urgent laparotomy,there is growing evidence to support delayed/selective surgeries,for the more convenient use of patches to reduce the recur-rent hernia.