创伤性腹壁疝一例报告

创伤性腹壁疝(traumatic abdominal wall hernias,TAWH)是一种罕见的疝类型。据报道[1],3 947例钝性外伤病人中,TAWH发生率约为0.9%。在成人中,TAWH最常见的原因是高能量性外伤,如机动车事故[2]。在儿童中,大多数这些病例的损伤原因是自行车事故,因此也称为"车把疝"[3-4]。我院收治1例创伤性腹壁疝病人,现报告如下。     

创伤性腹壁疝八例诊治体会

虽然腹部闭合性损伤的患者临床上常见,但合并创伤性腹肇疝（traumatic abdominal wall hernia,TAWH）的情况少见。我院于1998年3月至2013年11月共收治创伤性腹壁疝患者共8例,现报告如下。     

腹壁巨大切口疝手术方法的选择

腹壁切口疝的外科治疗目前仍较为困难,尤其是巨大腹壁切口疝。巨大腹壁切口疝一般是指缺损在10CITI以上的手术后发生的腹壁缺损。其治疗上的困难主要有以下几个方面：①术后的切口疝发生率5o,4～10％,甚至更高;而且手术治疗面临的困难很多。②对于手术切口疝的治疗不能令人满意,直接修补的手术失败率约30％～67％。③手术后严重并发症的发生率也较高,甚至有不少病例死亡。这些严重问题的发生使得相当部分的外科医生对巨大腹壁切口疝的治疗望而却步。由于未能得到及时、有效的治疗,给病人带来长期的、不断加剧的痛苦。     

创伤性膈疝并腹壁疝1例报告

##正##患者女,44岁。因重物压伤致胸部及臀部疼痛伴胸闷4h于2009年6月18日入院。查体:神志清,痛苦貌,全身皮肤黏膜苍白。气管居中,胸廓对称,     

腹壁切口疝手术治疗方案(草案)

中华外科学会疝和腹壁外科学组对腹壁切口疝提出手术治疗方案(草案)作为实践中参考用。     

腹壁切口疝的手术修补方法选择

腹壁切口疝的外科治疗仍较困难,并存有较大争议。有以下几个方面的原因：（1）术后的切口疝发生率高达5％～10％,甚至更高;（2）对于手术切口疝的治疗不能令人满意,直接修补的手术失败率可高达30％～67％;（3）手术后严重并发症的发生率也较高,甚至有不少病例死亡。以上这些严重问题的发生使得相当部分的外科医生对手术切口疝的治疗望而却步。由于未能得到及时、有效的治疗。给患者带来长期的、不断加剧的痛苦。[第一段]     

创伤性膈疝/创伤性膈破裂的早期诊治体会

目的：进一步探讨创伤性膈疝／创伤性隔破裂的早期诊治，以提高治愈率。方法：分析，总结我院近年收治的创新性膈疝／创伤性隔破裂病例资料。结果；本组病例无死亡，全部愈，其中有1例右侧膈疝，延迟至3年后治愈。结论：提高临床医师对本病的认识水平，并对可疑的病人进行严密观察和动态分析，降低死亡率，提高本病治愈率的关键。     

腹股沟疝、股疝和腹壁切口疝手术治疗方案(草案)

为便于广大读者在阅读本刊此期“大家谈”栏目时参阅涉及《草案》的有关内容,本刊在征得学组同意后,将原刊于《中国实用外科杂志》的该《草案》原格式刊出,特此说明。     

自体腹壁真皮片修补腹壁巨大切口疝

我院自 1980～ 2 0 0 1年采用自体腹壁真皮片修补腹壁巨大切口疝 (大于 10ｃｍ) 2 9例 ,效果满意。现报告如下。临床资料1.一般资料 :本组 2 9例 ,男 9例 ,女 2 0例。年龄 44～79岁 ,平均年龄 6 2 7岁。 1次腹部手术史 8例 ,2次腹部手术史 18例 ,3次腹部手术史 2例 ,4次腹部手术史 1例 ;疝环最大 2 2ｃｍ× 13ｃｍ ,最小 10ｃｍ× 7 5ｃｍ。2 手术方法 :有效麻醉使腹壁肌肉充分松弛 ,龙胆紫将疝环以虚线标出 ,捏起松弛皮肤估计皮肤切除范围 ,以修补缝合时无张力为准并以龙胆紫实线标出 ;依实线以缺损为中心做梭形切口至深筋膜。巨大切口疝…     

补片修补腹壁切口疝的治疗经验(附50例报告)

腹壁切口疝是临床上腹部外科手术常见的并发症之一，占各类疝总数3%左右，腹外疝的第3位[1]。随着老龄化社会的到来，其发生率有增高趋势。笔者自1999年4月以来采用巴德补片修补切口疝50例效果满意，报告如下。临床资料1.一般资料本组50例病人，男22例，女28例，年龄26～88岁，平均为52岁。其中4次复发者2例，3次复发者4例，2次复发者9例，余为初发疝;病史1～18年，小切口疝11例，大切口疝15例，巨大切口疝24例，上腹部切口疝31例，下腹部切口疝19例。2.修补材料采用美国巴德公司生产的补片(聚丙烯和聚四氟乙烯的双面材料)。聚丙烯材料不能…     

Concurrent Gastric Bypass and Repair of Anterior Abdominal Wall Hernias

Background: Many patients seeking surgical treatment for morbid obesity present with anterior abdominal wall hernias. Although principles of hernia repair involve a tension-free repair with the use of prosthetic mesh, there is concern about the use of mesh in gastric bypass surgery due to potential contamination with the contents of the gastrointestinal tract and resultant mesh infection. We report our series of patients undergoing Roux-en-Y gastric bypass (RYGBP) and simultaneous anterior abdominal wall hernia repair. Methods: All patients who underwent simultaneous RYGBP surgery and anterior abdominal wall hernia repair were reviewed. Results: 12 patients underwent concurrent RYGBP and anterior wall hernia repair. There were 5 women and 7 men with average age 54.9 ± 8.5 years (range 35 to 64) and average body mass index (BMI) 50.4 ± 10.3 kg/m² (range 38 to 70). Two open and 10 laparoscopic RYGBP operations were performed. Nine patients (75%) underwent incisional hernia repairs and 3 patients (25%) underwent umbilical hernia repair concurrent with gastric bypass. Average size of defect was 14.7 ± 13.4 cm². One patient had primary repair and 11 patients had prosthetic mesh repair: polypropylene in 3 patients (25%) and polyester in 8 patients (67%). With a 14.1 ± 9.3 month follow-up, there have been no mesh infections and 2 recurrences, one in the patient who underwent primary repair and one in a patient repaired with polyester mesh but with two previous failed incisional hernia repairs. Conclusion: Concurrent RYGBP and repair of anterior abdominal wall hernias is safe and feasible. In order to optimize success, tension-free principles of hernia repair with the use of prosthetic mesh should be followed since no mesh infections occurred in our series.     

腹壁疝发生和复发的生化因素

腹壁疝是普外科最常见的疾病之一。然而，有关其发生和修补术后复发的明确病因仍未完全明了。目前的研究表明，间质结缔组织特别是胶原的代谢异常与疝的发生和复发密切相关。疝与结缔组织异常性疾病的关系腹股沟疝在一些先天性结缔组织异常的疾病中发病率较高，如成骨不全、皮肤松弛、埃勒斯鄄当洛斯（Ehlers鄄Danlos）综合征、胡尔勒鄄亨特(Hurler鄄Hunter)综合征和马凡（Marfans）综合征等。在患有先天性髋关节脱位的儿童中，腹股沟疝的发病率分别高于正常男女儿童的５倍和３倍。另外，腹股沟斜疝病人容易合并关节活动过度，这部分病人…     

Safety and Efficacy of Laparoendoscopic Single-Site Surgery for Abdominal Wall Hernias

Background:

Laparoendoscopic single-site surgery has rapidly progressed from the animal laboratory to clinical use since mass production of multichannel ports began in 2007. Indeed, it has now been shown to be feasible and safe for many commonly performed operations.

Methods:

This study cohort comprised 22 unselected patients with abdominal wall hernias of varying types: multiply recurrent inguinal (n=2), suprapubic (n=1), ventral/incisional (n=17), and parastomal hernias (n=2), who underwent laparoendoscopic single-site ventral hernia repair between December 2009 and February 2011. Standard dissecting instruments and a 52cm/5.5mm/30^°angle laparoscope were used.

Results:

Patients included 14 men and 8 women, with a median age of 56 (range, 32 to 78) years and a mean body mass index of 31.5±4.7kg/m². The mean mesh size was 460cm² (range, 225 to 884cm²). Mean operation time was 125 minutes for ventral/incisional hernias and 270 minutes for parastomal hernias. No conversions to multiport or open surgeries were necessary. There was no mortality or morbidity, and no recurrence at 6- to 18-month follow-up. The mean satisfaction score was 2.7 (range, 2 to 3) with no patients reporting dissatisfaction with the procedure.

Conclusion:

This series, though relatively small, represents a diverse group of patients with varying abdominal wall hernias, including parastomal hernias. These successful laparoendoscopic single-site surgeries, with no complications, demonstrate safety and efficacy, albeit in a specialized hernia center. This study is a prelude to the eventual validation of laparoendoscopic single-site hernia surgery with prospective randomized controlled trials.     

Impact of Abdominal Wall Hernias and Repair on Patient Quality of Life

Background

The modified Activities Assessment Scale (AAS) is a 13-question abdominal wall quality of life (AW-QOL) survey validated in patients undergoing ventral hernia repair (VHR). No studies have assessed AW-QOL among individuals without abdominal wall pathology. The minimal clinically important difference (MCID) of the modified AAS and its implications for the threshold at which VHR should be offered also remain unknown. Our objectives were to (1) establish the AW-QOL of patients with a clinical abdominal wall hernia versus those with no hernia, (2) determine the MCID of the modified AAS, and (3) identify the baseline quality of life (QOL) score at which patients derive little clinical benefit from VHR.

Methods

Patient-centered outcomes data for all patients presenting to General Surgery and Hernia Clinics October–December 2016 at a single safety-net institution were collected via a prospective, cross-sectional observational study design. Primary outcome was QOL measured using the modified AAS. Secondary outcome was the MCID.

Results

Patients with no hernia had modified AAS scores of 81.6 (50.4–94.4), while patients with a clinically apparent hernia had lower modified AAS scores of 31.4 (12.6–58.7) (p < 0.001). The MCID threshold was 7.6 for a “slight” change and 14.9 for “definite” change. Above a modified AAS score of 81, the risk of worsening a patient’s QOL by surgery is higher than the chances of improvement.

Conclusions

VHR can improve 1-year postsurgical AW-QOL to levels similar to that of the general population. The MCID of the modified AAS is 7.6 points. Patients with high baseline scores should be counseled about the lack of potential benefit in QOL from elective VHR.