术前渐进性气腹在切口疝治疗中的应用

目的分析术前渐进性气腹（PPP）在复杂切口疝治疗中的应用效果和安全性。 方法采用回顾性横断面研究方法，收集2015年1月至2017年2月中山大学附属第六医院胃肠、疝和腹壁外科收治的21例采用PPP行切口疝修补术患者的临床资料，患者在气腹前后均行腹部CT检查，计算疝囊容积、腹腔容积。 结果21例患者均完成气腹，平均气腹时间（16.6±1.8）d，平均注入的空气量（3.7±0.9）L；4例（19.0%）发生与PPP相关的并发症，包括1例皮下气肿和3例肩胛痛；气腹前后平均疝囊容积分别是（901.0±430.8）ml和（1 115.1±481.9）ml,腹腔容积分别是（6 741.9±1 746.9）ml和（8 962.3±2 272.9）ml,(疝囊容积/腹腔总容积)×100%分别是（12±5）%和（11±4）%，差异均有统计学意义(t=11.3、12.4、2.9，均P<0.01)；气腹后疝囊容积与腹腔容积平均分别增加26.0%、33.7%，多数患者疝内容物自发性减少。21例患者均顺利完成手术，无一例发生肠管损伤，平均手术时间和术后住院天数分别为（180.1±50.6）min、（11.4±9.0）d，腹壁缺损均完全关闭；术后出现血清肿2例，呼吸困难1例，肺炎1例，均经对症治疗后好转，未出现腹腔高压、心肺功能衰竭等严重并发症。平均随访时间（13.0±8.0）个月，无一例疝复发。 结论PPP应用于切口疝安全有效，允许疝内容物完全回纳腹腔。

Application of preoperative progressive pneumoperitoneum in treating complex incisional hernia repair

ObjectiveTo analyze the efficacy and safety in the treatment of patients with progressive pneumoperitoneum (PPP) prior to elective repair of the complex incisional hernia. MethodsThis retrospective study assessed twenty-one patients between January 2015 and February 2017 with complex incisional hernias. All patients underwent serial computed tomography of the abdomen with volume measurements of the peritoneal cavity and hernia sac before and after pneumoperitoneum. ResultsTwenty-one patients successfully completed the pneumoperitoneum. The mean overall duration of pneumoperitoneum was (16.6±1.8) days, the mean insufflated volume of air was (3.7±0.9) L; 4 patients (19.0%) suffered from pneumoperitoneum-related complications, consisting of one subcutaneous emphysema and three of scapular pain. Before and after PPP, the mean volume of the incisional hernia (VIH) was (901.0±430.8) ml, (1 115.1±481.9) ml, the mean volume of the abdominal cavity (VAbC) was (6 741.9±1 746.9) ml, (8 962.3±2 272.9) ml, VIH/(VIH+VAbC)×100% was (12±5)% and (11±4)%, the differences were statistically significant (t=11.3, 12.4, 2.9, all P<0.01). The mean gain in volume of the hernia sac was 214 ml (26.0%) and the abdominal cavity was 2 220 ml (33.7%) after PPP. Most patients showed spontaneous reduction of the hernia contents. The operations of all patients were successful, no bowel injury was found, the mean operative time and postoperative length of stay were (180.1±50.6) min, (11.4±9.0) d. Complete closure of the abdominal wall defect was performed in all patients. Postoperatively, there were 2 cases of seroma, 1 case of dyspnea, 1 case of pneumonia, all patients were better after symptomatic treatment. There were no patients experiencing abdominal hypertension and cardiorespiratory failure postoperatively. After a mean follow-up of (13.0±8.0) months, there were no hernia recurrences. ConclusionsPPP is a useful adjunct in complex ventral hernia repair, allowing the reintroduction of herniated content into the abdominal cavity. Simultaneously, pneumoperitoneum has an acceptable overall morbidity.