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如何对腹壁巨大缺损,特别是腹壁肿瘤扩大切除术后形成的腹壁缺损进行有效修复重建至今仍是困扰外科医师的一大难题。在腹壁缺损修复前对其进行准确的分型是选择恰当手术方案的基础,也是术后比较与判断其疗效的前提。对术前病人状况进行认真评估及针对性的准备是进行手术的必要条件。了解并正确掌握植入材料修复技术、组织结构分离技术及自体组织移植技术并根据腹壁缺损的类型、大小及周围组织状况选择合理的术式是腹壁巨大缺损修复重建成功的保证。     

生物补片加强开放与内镜组织结构分离技术修复腹壁缺损

目的 比较基于生物补片加强的开放组织结构分离技术与内镜组织结构分离技术修复腹壁缺损的效果.方法 回顾性分析上海交通大学医学院附属第九人民医院普外科2012年1月-2013年12月收治的19例基于生物补片加强的开放组织结构分离技术和内镜组织结构分离技术修复腹壁缺损患者的临床资料,其中行开放组织结构分离技术修复者11例,行内镜组织结构分离技术修复者8例,比较两组患者的临床治疗效果.结果 平均随访（14.96±8.89）个月,两组患者均无缺损复发,术中平均出血量：开放组织结构分离技术组（362.18 ±517.15） mL高于内镜组织结构分离技术组（255.00±148.03） mL;平均手术时间及住院时间：开放组织结构分离技术组（195.00±71.93） min、（20.45±0.28）d分别低于内镜组织结构分离技术组（211.75±70.79） min、（24.50±12.49）d;切口并发症发病率：开放组织结构分离技术组（18.2％）高于内镜组织结构分离技术组（12.5％）,但差异无统计学意义（P＞0.05）.结论 基于生物补片加强的开放组织结构分离技术与内镜组织结构分离技术均可有效用于腹壁缺损的修复重建,内镜组织结构分离技术在降低切口并发症发病率方面具有一定的优势,但还需大样本、长期的临床随访进行证实.     

内镜组织结构分离技术在巨大腹壁切口疝治疗中应用价值

巨大腹壁切口疝（LIH）由于其治疗的复杂性使其至今仍是腹壁外科医师所必须面对的挑战。在腹部缺损关闭基础上实施腹壁加强修补是腹壁重建的基本原则,建立在组织结构分离基础上的内镜组织结构分离技术（ECST）为腹壁缺损的关闭提供了重要的支持与帮助,不仅可以更小的创伤实现与开放组织结构分离技术同样的腹壁重建效果,而且显著降低并发症的发生率,改善病人生活质量。准确掌握与正确实施ECST对于LIH的治疗具有重要意义。     

巨大腹壁缺损伴腹壁功能不全外科治疗

如何对巨大腹壁缺损伴腹壁功能不全（LOD）病人进行腹壁缺损的修复与重建至今仍是困扰腹壁外科医生的一大难题。了解LOD发病机制、准确进行术前评估及充分的术前准备是LOD病人手术成功的保证。植入材料加强修补技术是LOD病人治疗的基础,基于植入材料的组织结构分离技术或自体组织移植技术为LOD病人成功进行腹壁重建提供了重要帮助。     

组织结构分离技术在疝外科中的临床应用

近年来,腹壁组织结构分离技术在国内外主要被应用于腹壁缺损的修补与腹壁重建中,特别是针对腹壁巨大缺损的修补,而联合应用腹腔镜微创技术以及人工合成补片更体现出该技术在腹壁重建中的优势.本文着重就组织结构分离技术的手术原理、适应证、优势、操作方法、并发症及相关应用进展作一综述.     

乳腺癌术后乳房重建的腹壁缺损修复基本原则及材料选择

乳腺癌根治性切除术后的自体乳房重建目前已被广泛应用于临床,但某些术式的自体乳房重建手术会造成一定程度的腹壁缺损。腹壁缺损导致腹壁正常功能的缺失,进而引起一系列严重的病理生理学改变。目前常用的手术方式有带蒂腹直肌皮瓣和腹壁下深动脉穿支皮瓣的乳房重建。根据乳腺癌术后乳房自体重建术后不同的腹壁缺损的类型,应该在严格遵循腹壁修复的基本原则的基础上,制定相应的手术修补方案。同时根据不同的腹壁缺损范围选择适当的腹壁修复材料。乳房重建术后形成的腹壁缺损通常其腹直肌后鞘和腹膜是完整的,腹直肌前鞘也可能保留,手术方式可选择腹壁不同层次的修复,同时强调应用修补材料进行修复。     

组织结构分离技术规范化操作中国专家共识(2020版)

复杂腹壁缺损的修复与重建是困扰腹壁外科医师的难题,理想的治疗效果不仅是要恢复腹壁的解剖完整性与外观,更要恢复腹壁的功能,通过腹壁重建达到治疗腹壁缺损的目的。腹壁重建的核心是关闭腹壁缺损,而如何关闭各种大或巨大腹壁缺损,并在此基础上进行腹壁缺损的修复重建是腹壁外科医师必须面对的重大挑战[1]。自20世纪90年代以来,在基于对腹壁解剖、生理及功能深入认识的基础上出现的组织结构分离(component separation,CS)技术为解决此问题提供了一种有效方案,由于其能够帮助实现各种大或巨大腹壁缺损的关闭,因此,该术式及其各种改进技术得到越来越广泛的应用与推广[2-3]。我国于2010年左右开始应用CS技术治疗各种大或巨大腹壁缺损[4],目前开展此技术的医院和例数明显增多,但尚缺乏相应的手术操作规范。     

A型肉毒素用于巨大切口疝修补的辅助治疗

正切口疝是腹部手术后常见的并发症,其发生率在20%左右。对于有高危因素的病人,手术后切口疝的发生率可高达35%~([1-2])。切口疝修补的关键是关闭腹壁缺损和重建腹壁功能。随着腹壁外科技术的发展,已有多种术中应用的技术降低腹壁肌肉张力,包括前组织结构分离~([3])、后组织结构分离加腹横肌松解术~([4])等。但对于巨大切口疝,这些技术仍不能     

腹壁肿瘤切除术后巨大/超大腹壁缺损的外科修复重建策略

腹壁肿瘤、尤其是恶性肿瘤R0切除术后会导致巨大、甚至超大腹壁缺损,选择合理的腹壁修复重建技术是治疗关键。本文总结了腹壁恶性肿瘤的临床特点、治疗现状、肿瘤扩大切除后腹壁缺损的术前评估和腹壁缺损修复重建的术式选择;重点阐释了腹壁缺损类型、缺损大小、缺损周围组织情况和患者全身情况对术式选择的重要性。     

胸廓严重缺损畸形的整复治疗

目的探讨先天性胸廓严重缺损及凹陷畸形的整复手术方法。方法(1)对于胸一腹型联体婴分离术后造成胸腹部组织器官缺损，采用非生物修补材料进行修复与重建，同时设计多个大型皮瓣转移修复胸腹壁巨大创面。(2)采用大块自体胸骨瓣游离移植矫治漏斗胸严重凹陷畸形。结果3例分别采用自体骨、硅胶假体、外科涤纶修补材料以及设计多个大型皮瓣修复创面，全部获得成功，创口一期愈合。结论胸廓严重缺损畸形的整复治疗是整形外科的一项高难度手术，既复杂又有很大危险性，但其治疗效果却较为确实、有效。     

The component separation technique for hernia repair: a comparison of open and endoscopic techniques

The open components separation technique (CST) for hernia repair allows for autologous tissue repair with approximation of the midline fascia in patients with complex hernias. CST requires creation of large undermining skin flaps, whereas the endoscopic component separation technique (ECST) is performed without division of the epigastric perforating vessels and may minimize wound morbidity. A review of patient demographics and outcome measures of patients undergoing CST and ECST between November 2008 and February 2010 was performed. Twenty-five patients were identified who underwent either CST (14 patients) or ECST (11 patients). There were no differences in body mass index (CST 34.8 kg/m(2), ECST 37.5 kg/m(2), P = 0.45), operating room times (CST 268 minutes, ECST 252 minutes, P = 0.54), or hospital length of stay (CST 5 days, ECST 5.8 days, P = 0.78). Wound complications occurred less with ECST (9 vs 57%, P = 0.03). The time to resolution of wound complications in ECST was reduced *1 vs 4 months). No recurrences were seen in either group with a mean follow-up of 4months (range, 1 to 12 months). ECST and CST require similar operative times and hospital lengths of stay. ECST is associated with reduced wound complications compared with CST. Short-term recurrence rates with CST and ECST are comparable.     

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??Treatment of large incisional hernia with endoscopic component separation technique GU Yan, YANG Jian-jun, SONG Zhi-cheng. Hernia and Abdominal Wall Disease Center??Shanghai Jiao Tong University; Department of General Surgery??Shanghai Ninth People’s Hospital??Shanghai Jiao Tong University School of Medicine??Shanghai 200011??China
Corresponding author??GU Yan??E-mail??yangu@sjtu.edu.cn
Abstract Treatment of large incisional hernia (LIH) is still a challenge to most of the abdominal wall surgeons due to unacceptable high morbidity and recurrence rates. Reconstruction of the abdominal wall based on close of the defect and mesh reinforcement is essential for treatment of LIH. Endoscopic component separation technique (ECST) provides significant assistances for abdominal wall reconstruction, which not only has similar reconstruction results as open component separation with minimally surgical procedures , but also decrease the morbidity significantly. Understanding the correct procedure of ECST is very important for LIH reconstruction.     

腹腔镜联合组织结构分离技术治疗造口旁疝16例疗效分析

目的 探讨腹腔镜联合组织结构分离技术（CST）在造口旁疝治疗中的应用 方法 回顾性分析2012年1月至2015年1月哈尔滨医科大学附属第四医院应用腹腔镜联合CST治疗的16例造口旁疝病人的临床资料。结果 均顺利完成腹腔镜手术,手术时间为70～250（152.9±60.8）min。术后发生血清肿2例,切口感染1例,疼痛2例（3～4周缓解）。经非手术治疗,病人顺利出院。随访6～15个月,16例病人恢复腹壁有效外观,正常参与呼吸和协调身体其他部位的运动,达到腹壁功能重建的效果。所有病人无慢性疼痛及造口旁疝复发。 结论 腹腔镜联合CST修补造口旁疝,恢复腹壁结构连续性的同时达到腹壁的功能性重建,手术兼具腹腔镜创伤小、干扰轻、恢复快等优点,降低了疝的复发率。     

How to perform the endoscopically assisted components separation technique (ECST) for large ventral hernia repair

Background

The components separation technique (CST) is frequently used for reconstructing large ventral hernias. Unfortunately, it is associated with a high wound complication rate up to 50 %, caused by large wound surface and inherent trauma to abdominal skin vascularization. An endoscopically assisted modification of the original technique (ECST) spares skin vascularization and reduces wound surface, supposedly reducing wound complications. This study accurately describes ECST step by step with detailed illustrations and report the results of a 27 patient cohort.

Methods

Since September 2012 patients with midline hernias without previous subcutaneous dissection and a maximum diameter of approximately 10–15 cm underwent ECST in an expert centre for abdominal wall reconstructions. Prospective data was gathered during inpatient care and 3–6 monthly follow-up.

Results

Twenty-seven patients (17 male/10 female) with median age of 60 years (range 35–77), average BMI 27 (SD ±2) kg/m² and median ASA classification 2 (range 1–3) underwent ECST. Two patients were excluded due to bilateral conversion to conventional CST and finding of peritoneal metastases. Median defect size was 116 ± 48 cm². Median length of stay was 5 days (range 3–15). Wound complication rate was 11 %. Recurrence rate was 29 % after a median follow-up of 13 months.

Conclusions

Endoscopically assisted modification of the original technique can be used for reconstructing large and complex ventral hernias up to 15 cm in diameter. The results of this small sized cohort study showed that ECST is feasible in patients with a uro-, or enterostomy and suggest that ECST reduces wound complication rate when compared to CST.

     

Repair of Giant Midline Abdominal Wall Hernias: “Components Separation Technique” versus Prosthetic Repair

BACKGROUND: Reconstruction of giant midline abdominal wall hernias is difficult, and no data are available to decide which technique should be used. It was the aim of this study to compare the "components separation technique" (CST) versus prosthetic repair with e-PTFE patch (PR). METHOD: Patients with giant midline abdominal wall hernias were randomized for CST or PR. Patients underwent operation following standard procedures. Postoperative morbidity was scored on a standard form, and patients were followed for 36 months after operation for recurrent hernia. RESULTS: Between November 1999 and June 2001, 39 patients were randomized for the study, 19 for CST and 18 for PR. Two patients were excluded perioperatively because of gross contamination of the operative field. No differences were found between the groups at baseline with respect to demographic details, co-morbidity, and size of the defect. There was no in-hospital mortality. Wound complications were found in 10 of 19 patients after CST and 13 of 18 patients after PR. Seroma was found more frequently after PR. In 7 of 18 patients after PR, the prosthesis had to be removed as a consequence of early or late infection. Reherniation occurred in 10 patients after CST and in 4 patients after PR. CONCLUSIONS: Repair of abdominal wall hernias with the component separation technique compares favorably with prosthetic repair. Although the reherniation rate after CST is relatively high, the consequences of wound healing disturbances in the presence of e-PTFE patch are far-reaching, often resulting in loss of the prosthesis.     

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??Curative effect of laparoscope and component separation technique in the treatment of parastomal hernia: An analysis of 16 cases LIU Chang??SUN Xu-yang??JI Yan-chao??et al. Department of General Surgery??the Fourth Affiliated Hospital of Harbin Medical University??Harbin 150001??China
Corresponding author??LIU Chang??E-mail??changliu72@163.com
Abstract Objective To study the effectiveness of using laparoscope and component separation technique (CST) to cure parastomal hernia. Methods The clinical data of 16 cases of parastomal hernia performed laparoscopy and CST from January 2012 to January 2015 in the Fourth Affiliated Hospital of Harbin Medical University were analyzed retrospectively. Results The operation time ranged from 70 to 250 minutes with a mean of ??152.9±60.8??min. The postoperative seroma occurred in 2 cases. One case had incisional infection. Two cases had abdominal pain and most of the pain could be alleviated in 3-4 weeks. They were followed up for 6-15 months. A total of 16 cases were performed laparoscopy and CST to cure parastomal hernia restored abdominal wall appearance effectively, normal breathing and coordination of movement in other parts of the body??to achieve the effect of abdominal wall function reconstruction. All the cases had no chronic pain and recurrence. Conclusion Laparoscope and CST have the advantages of minor injury??light interference??quicker recovery, which can not only restore the continuity of the abdominal wall structure and achieve the functional reconstruction of abdominal wall??but also reduce recurrence of hernia.     

Herniated gravid uterus through an incisional hernia treated with the component separation technique

Herniation of a gravid uterus through an incisional hernia of the anterior abdominal wall is a rare but serious condition due to the potentially severe maternal and foetal risks. Because of the rarity of the condition, no consensus exists regarding the optimal treatment. The component separation technique (CST) has proven to be effective for the treatment of those giant abdominal hernias in which prosthetic material utilisation is not indicated. We report the case of a woman who presented at 38 weeks of gestation with non-reducible herniation of the pregnant uterus through an anterior abdominal wall incisional hernia treated with CST immediately after caesarean section. Review of the existing literature is performed to further underline the efficacy of CST and the need for the practising surgeons to be familiar with this technique and the scenarios when it may become extremely valuable.