应用补片治疗巨大腹壁切口疝的体会

目的 探讨腹壁切口疝的易发因素、发病机理及其防治方法。方法 对2000年10月-2005年9月收治的26例巨大腹壁切口疝患者的临床资料进行回顾性分析。结果 所有病例均采用补片行巨大切口疝无张力修补术，其中采用Marlex网片17例，复合补片（Composix 补片）9例，全组病例均痊愈出院，无严重并发症，随访6-35个月，平均26个月，无复发，疗效满意。结论腹内压增高、术后切口感染、手术操作不规范是腹壁巨大切口疝发生的主要原因；固手术期管理，包括处理腹内压改变对机体的不利影响、抗生素使用积极防治切口感染、术后的康复指导等是防止该病发生及决定其治疗预后的关键；应用人工补片行腹壁巨大切口疝修补术是一种安全、合理、疗效确切的最佳治疗方法，也是治疗该病的发展方向。

Experience of remedy for abdominal giant incisional hernia by patch

[Objective] To explore the etiology, prevention and treatments of abdominal giant incisional hernia(AGIH). [Methods] The clinic data of 26 cases with AGIH in our hospital from Oct.2000 to Sep.2005 were analyzed retrospectively. [Results] All the cases were successfully treated by using tension-free herniorrhaphy with the Patch, 17 of them chose the Composix patch, and 9 chose the Marlex patch. The cases were all cured, and had no serious postoperative complications. None of the cases recurred during a follow-up of 6 to 35 months and the effect was satisfied. [Conclusions] The increase of intra-abdominal pressure, the infection of incision and the irregular operation are the main reasons of AGIH. The perioperative management is of great importance to the prevention and prognosis of AGIH, it mainly includes the management of adverse effects to the body because of the changes of intra-abdominal pressure, the use of prophylactic antibiotics to prevention incisional infection and the education of postoperative convalesce guide. Repairing AGIH with artificial patch is a safe, rational and effective measure, also the direction indicator of AGIH therapy.