腹壁巨大缺损修补术后并发症防治

腹壁巨大缺损的临床治疗困难,腹壁重建是其治疗的主要手段。而全身性、腹壁本身以及各种技术相关并发症的发生均会对其重建效果产生不利影响。充分认识腹壁巨大缺损修补术后可能发生的各种常见并发症,进行认真的术前准备和评估、选择正确的术式、术后密切观察与及时处理是降低巨大腹壁缺损术后并发症发生率的关键。     

自体组织移植修补腹壁巨大缺损

腹壁缺损可由创伤或腹壁肿瘤切除造成的原发性大面积腹壁缺失,也可由手术切口或肠造口造成疝,以及疝修补失败、合成材料修补术后感染、复发等继发形成[1,2],其发生率约为2%～11%[3]。如缺损大(巨大切口疝:疝环最大距离≥10cm),可用自体组织移植或人工合成材料修补,目前临床上广     

腹壁肿瘤切除术后遗留腹壁巨大缺损39例修复与重建

目的探讨采用聚丙烯（Polypropylene,PP）补片或复合补片修复腹壁肿瘤切除术后遗留腹壁巨大缺损的方法和效果。方法收治的39例腹壁巨大肿瘤患者均采取了手术切除治疗。采用直接缝合腹膜关闭腹腔,并在腹膜外用PP补片修复缺损6例,采用带蒂大网膜加PP补片修复缺损19例,采用复合补片修补腹壁缺损14例。结果 39例中因术后发生急性心肌梗塞死亡1例。术后肺部感染1例,经抗感染治疗治愈。术后出现皮下积液5例,经穿刺抽吸,理疗和引流等措施治愈。随访34例,随访时间1～5年。在访的4例结肠癌患者和4例胃癌患者术后12～27个月均因肿瘤腹腔内复发及肝脏广泛转移死亡,术后肿瘤局部复发1例,随访的全部患者未发生腹壁切口疝和肠梗阻等并发症。结论采用PP补片或复合补片修复腹壁肿瘤切除后遗留腹壁巨大缺损并发症发生率低,效果良好。     

应用人工材料——Marlex网修补腹壁缺损

目的;总结应用人工材料聚丙烯网修补腹壁缺损。方法：通过手术修补腹壁缺损：其中切口疝１３例,腹股沟疝３２例,腹壁肿瘤１９例,结果：术后切口感染１例,皮下积液３例,其余病例切口Ⅰ期愈合,随诊４１例,未发现疝的复发和形成,结论：认为聚丙烯网是一种理想的修补腹壁缺损的材料。     

腹腔内置PROCEED网片修补巨大腹壁缺损三例

获得性腹部缺损的常见病因有外伤、手术、感染等.笔者应用腹腔内置PROCEED外科网片修补法修补3例巨大腹部缺损患者,报道如下.     

腹壁整形加聚丙烯网片修复巨大下腹壁缺损

目的探讨应用横切口腹壁整形术与聚丙烯网片联合修复下腹壁缺损的方法。方法应用横行切13腹壁整形加聚丙烯网片的手术方法，修复27例下腹壁缺损，其中6例下腹壁病灶切除，21例下腹横行腹直肌肌皮瓣（以下简称TRAM瓣）供区。结果随访3～20个月，腹壁病灶均彻底切除，术后未见复发，所有患者无腹壁薄弱、腹壁膨隆或腹壁疝形成，腹壁切口、一期愈合，无并发症。结论横行切口腹壁整形加聚丙烯网片修复下腹壁缺损，方法简单、效果可靠。     

创伤性腹壁巨大缺损一期修复1例

病人男,25岁.左侧腹壁机器皮带绞伤6h于2005年11月急诊入院.曾在当地医院就诊,行小肠破裂修补术后因腹壁缺损无法处理转院.入院查体:生命体征平稳,左侧腹壁中下部盖大碗包扎.立即全麻下行探查清创术.     

复合补片修补腹壁肿瘤切除后巨大腹壁缺损的临床疗效

目的探讨复合补片修补腹壁肿瘤切除后巨大腹壁缺损的临床疗效。 方法回顾性分析2015年2月至2017年8月,新疆医科大学第四附属医院收治的55例腹壁肿瘤切除术后巨大腹壁缺损患者临床资料,根据植入补片的不同分为试验组（35例）和对照组（20例）,2组患者均行腹壁肿瘤切除术,试验组植入Proceed补片,对照组植入Composix Kugel补片。比较2组手术相关临床参数、手术前后不同时间疼痛程度、切口愈合情况、并发症、肿瘤复发及转移情况。 结果2组铺置补片时间及术后自主活动时间比较,差异无统计学意义（P>0.05）。术后12 h至7 d,2组患者视觉模拟评分均呈逐渐降低趋势,且均明显低于术前（P<0.05）,但2组间均无明显差异（P>0.05）。拆线后伤口均达到一期愈合,2组总并发症发生率比较,差异无统计学意义（P>0.05）。随访1年,试验组肿瘤原位复发1例,对照组肿瘤远处转移1例,2组患者腹壁修复材料腹腔面光滑,且均未见腹壁修复材料与肠管黏连。 结论采用Proceed补片和Composix Kugel补片对腹壁肿瘤切除后巨大腹壁缺损进行修复和重建,效果均较好,安全性高。     

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…     

腹壁巨大缺损的外科治疗

腹壁外伤、肿瘤切除、感染以及腹部手术后切口裂开是引起腹壁巨大缺损的主要因素，腹壁缺损已是腹部外科的常见病，其中由于腹部手术切口愈合不良引发的腹壁巨大缺损所致切口疝者占10％～20％。虽然腹壁巨大缺损的治疗方法诸多，但选择一个适宜的治疗方式仍然是一个难题。不恰当的治疗将会引起严重后果，甚至会危及病人的生命。本文结合笔者的临床经验以及众多学者的研究对腹壁巨大缺损的外科治疗进行简单的阐述。     

内镜组织结构分离技术治疗腹壁缺损

如何有效进行复杂腹壁缺损的修复与重建一直是困扰腹壁外科医师的一个难题,传统的组织结构分离技术虽然能够通过自体组织推进实现腹壁缺损的功能性修复,但其广泛皮瓣分离所导致的切口并发症是其重要不足。而内镜组织结构分离技术由于可保护腹壁穿支血管,因此具有并发症少、恢复快、术后住院时间短的优点。作为一种自体组织修复的重要手段,内镜组织结构分离技术必将在腹壁缺损修复重建中发挥越来越重要的作用。     

Vertical abdominal fasciocutaneous flaps in the reconstruction of chest wall defects

The use of a vertical abdominal fasciocutaneous flap in the reconstruction of chest wall defects is described. The technique has been successfully used in 8 patients and the advantages of such a fasciocutaneous flap in chest wall reconstructions are emphasised.     

Total abdominal wall reconstruction

Total abdominal wall loss results in a difficult reconstructive problem. To obtain stable, durable soft-tissue coverage and restore fascial integrity, a number of reconstructive techniques are frequently required. Use of these techniques can achieve a functional and cosmetically acceptable reconstruction.     

Anterior abdominal wall reconstruction

Reconstruction of the anterior abdominal wall is based on six basic principles. First, the anatomy of the abdominal wall and adjacent donor sites must be understood clearly. This includes a complete knowledge of the neurovascular anatomy and the arc of rotation of each subunit. The defect then has to be exposed completely before the definitive closure is attempted. Once the defect is established, abdominal domain is restored with some sort of support. The next phase of the repair involves reassigning local tissue to close the defect. Distant tissue then is imported from donor sites such as the thigh, if needed. Finally, the skin envelope is readjusted and closed. These principles help optimize function and restore form, hence achieving the best possible result.     

Congenital anterior abdominal wall defects

Anterior abdominal wall defects are a common cause of morbidity and even mortality. These include gastroschisis, usually an isolated defect, and exomphalos, a more fundamental failure of abdominal wall formation often seen in association with chromosomal and other systemic anomalies. The worldwide incidence of gastroschisis has risen inexorably over the past 30 years while the incidence of exomphalos, at least at the time of birth, has been relatively static. This article provides an overview of the key aspects of antenatal, perinatal and postnatal management, highlighting areas of controversy where further study is required.     

Congenital anterior abdominal wall defects

Anterior abdominal wall defects are a common cause of morbidity and even mortality. These include gastroschisis, usually an isolated defect, and exomphalos, a more fundamental failure of abdominal wall formation often seen in association with chromosomal and other systemic anomalies. The worldwide incidence of gastroschisis has risen inexorably over the past 30 years while the incidence of exomphalos, at least at the time of birth, has been relatively static. This article provides an overview of the key aspects of antenatal, perinatal and postnatal management, highlighting areas of controversy where further study is required.     

Challenging abdominal wall defects.

BACKGROUND: We propose a simple algorithm for management of patients with challenging abdominal fascial defects. METHODS: The medical records of 64 patients with complicated abdominal wall defects representing a consecutive series by a single surgeon over a 4-year period were reviewed. Group I patients presented with massive fascial defects and closed wounds. They were reconstructed with autogenous tissue using either the separation of parts (SOP) procedure or free tensor fascia lata (TFL) grafts. Group 2 patients had fascial defects with open wounds. Wound closure was first accomplished with either STSG or primary skin closure over viscera. These patients, now "converted" into patients with closed wounds, were reconstructed months later as in group 1. RESULTS: Average defect size was 320 cm2. Wound closure was achieved in one procedure in all patients with open wounds. Time to discharge after this procedure averaged 9 days. The only morbidity of wound closure was skin graft donor site pain. Average time from temporary staged closure with skin grafts to definitive closure with autogenous tissue was 5 months. Repair of closed fascial defects with autogenous tissue was performed in 51 patients. Average time to discharge after autogenous tissue repair was 6.6 days. Recurrence of hernia was noted in 2 (3.9%) patients with an average follow-up of 24 months. CONCLUSIONS: Treatment of challenging abdominal wall defects can be accomplished simply and safely utilizing the above surgical algorithm. Open wounds are converted into closed wounds and fascial defects are repaired with autogenous tissue. This treatment plan has proved to be effective in a wide variety of situations.