腹壁巨大切口疝的围手术期处理

目的探讨腹壁巨大切口疝的特点及围手术期处理临床经验。方法对我院2003年1月至2008年1月间诊治的21例巨大腹壁切口疝患者的临床资料进行回顾性分析。结果21例患者疝环直径10—23cm，平均（14．4±5．2）cm，3例患者疝囊容积与腹腔容积的之比〉20％。11例患者术前存在腹内压增高因素。16例患者术前采用腹带加压捆扎方法，5例患者采用人工气腹法行腹腔扩容，2例放弃手术。引流管多在术后4～7d拔除，平均（5．4±1．6）d。2例发生皮下积液，腹带加压束腹2周，无切口感染或补片排斥反应，无围手术期死亡。14例患者获得随访，复发1例。结论对腹壁巨大切口疝患者应加强围手术期评估和准备，提高手术的安全性。

Perioperative management of huge abdominal incisional hernia

Objective To evaluate the clinical experience of perioperative management for huge abdominal incisional hernia. Methods Twenty-one patients with huge incisional hernia treated in our hospital from Jan. 2003 to Jan. 2008 were analyzed retrospectively. Results The hernial diameter was 10-23（14.4 ±5.2）cm, the percentage of the contents of the sac defined and the abdominal contents that have lost domain in 3 patients are more than twenty percent. Evidence increase of intraabdiminal pressure occurred in 11 patients. Preoperative pressure abdominal belt and induced pneumoperitoneum were used in 16 and 5 patients, respectively. The operation was aborted in 2 patients. Draining ducts were extracted during 4-7（5.4 ±1.6）days postoperatively. 2 patients oceurred subcutaneous dropsy. All patients use abdominal belt for two weeks postoperatively. No incisional infection or mesh rejection occurred. One recurrent case was found during the postoperative follow-up period. Condusion Perioperative evaluation and management is the most important for patients with huge abdominial incisional hernia.