从腹内压的视角再论复杂腹壁疝的综合治疗策略

Re-discussion on the comprehensive treatment strategy of complex ventral hernia from the perspective of intraperitoneal pressure

复杂腹壁疝是指巨大和(或)合并一系列并发症的腹壁疝, 其诊疗具有一定难度。腹内压变化是各因素影响围手术期风险或术后复发的核心途径之一。以腹内压重建为核心, 制定复杂腹壁疝的治疗策略, 可从提高患者耐受性、扩大腹腔容积和减小腹腔内容物体积三方面入手。提高患者耐受性的方法主要包括腹壁顺应性训练、渐进式人工气腹。扩大腹腔容积可采用植入材料修补、组织分离技术、自体组织移植、组织扩张技术、化学组织结构分离技术等。减小腹腔内容物体积有腹腔主动减容手术和暂时性腹腔关闭技术。临床实践中, 应根据复杂腹壁疝的病情特点和腹内压情况, 选择合理的个体化治疗措施。

Complex ventral hernia refers to a large hernia that is complicated by a series of concurrent conditions.Change in intra-abdominal pressure is one of the main pathways through which various factors exert an impact on perioperative risk and postoperative recurrence.Taking abdominal pressure reconstruction as the core,the treatment strategy for complex abdominal hernia can be formulated from three aspects:improving patients′tolerance,expanding abdominal cavity volume,and reducing the volume of abdominal contents.Improving patients′tolerance includes abdominal wall compliance training and progressive preoperative pneumoperitoneum.To expand the volume of the abdominal cavity,implanting hernia repair materials,component separation technique,autologous tissue transplantation,component expend technique,and chemical component separation can be used.Initiative content reduction surgery and temporary abdominal closure may be performed to reduce the volume of abdominal contents.For different cases of complex ventral hernia,personalized treatment measures can be safely and feasibly adopted depending on the condition of the patients and the intra-abdominal pressure situation.