复合修补在下腹巨大切口疝患者腹壁重建中的应用

目的下腹巨大切口疝由于缺损巨大且毗邻耻骨、髂血管等重要结构而修补困难,探讨联合应用腹腔内网片植入术及Sublay修补术修复下腹巨大切口疝的方法及疗效。方法 2008年11月-2010年8月,收治26例下腹巨大切口疝患者。男15例,女11例;年龄36～85岁,平均61岁。其中直肠癌术后切口疝11例(下腹正中切口),子宫切除术后切口疝6例(Pfannenstiel切口),膀胱切除术后切口疝9例(下腹正中切口)。11例既往曾行切口疝修补术。发生切口疝至入院时间为1～15年,平均8.5年。根据欧洲疝学会分型标准均为M3-4-5W3。疝环最长径为13～21cm,平均17.5cm。术前2周开始逐步扎紧腹带,直至将疝内容物全部还纳、患者体征平稳后,采用腹腔内网片植入术联合Sublay修补术重建腹壁。结果 26例均成功完成复合修补手术。术中见疝环面积为76.2～160.6cm2,平均112.5cm2;应用聚丙烯网片面积为75.3～170.5cm2,平均120.4cm2;应用复合补片面积为130.4～305.3cm2,平均220.0cm2。手术时间105.0～195.0min,平均155.5min;术后住院时间7～16d,平均12d。术后切口均Ⅰ期愈合;4例(15.4%)发生血清肿,3例(11.5%)发生下腹慢性疼痛,均经对症处理后缓解。患者均获随访,随访时间3～24个月,平均14.5个月。未见疝复发及其他不适。结论腹腔内网片植入术联合Sublay修补术具有覆盖完全、复发率低等优点,是治疗下腹巨大切口疝的有效方法;注意围手术期处理及手术细节是确保手术成功的关键。

APPLICATION OF COMPOUND REPAIR FOR RECONSTRUCTION OF ABDOMINAL WALL IN PATIENTS WITH GIANT LOWER VENTRAL HERNIA

Objective Surgical repair for giant lower ventral hernia is facing challenge owing to enormous tissue defect and the critical structures of pubis and iliac vessels.To investigate the method and curative effect of intraperitoneal onlay mesh(IPOM) combined with Sublay for compound repair of giant lower ventral hernia.Methods Between November 2008 and August 2010,26 patients with giant lower ventral hernia were treated.There were 15 males and 11 females with an average age of 61 years(range,36-85 years),includ...