应用补片法治疗腹壁巨大切口疝14例临床分析

目的探讨腹壁巨大切口疝的病因及用人工补片行无张力疝修补的临床效果。方法回顾性分析14例腹壁巨大切口疝的临床资料。结果14例中13例为纵切口，1例为肋缘下切口。肠破裂、肠梗阻、阑尾穿孔等致切口感染占42．86％（6／14），是其重要原因。有基础疾病糖尿病、高血压、冠心病、慢性咳嗽、低蛋白血症占21．43％（3／14）。疝出现最短1月，最长6年，平均2年。两次修补2例次，2例次同时行补片腹股沟斜疝修补。疝环直径均〉10cm，最大直径20cm，均采用人工补片无张力疝修补，随访3—56个月均治愈。仅2例出现切口下浆液肿及积液经引流后治愈。结论腹壁巨大切口疝的发生与使用腹壁纵切口、有糖尿病、慢性咳嗽、低蛋白血症及切口感染密切相关。术前行相关基础疾病治疗、腹壁适应性训练及手术使用人工补片修补效果满意，且操作简便，患者无腹壁紧缩感，不易复发，补片反应轻，值得推广。

Clinic analysis of surgical treatment of abdominal giant incisional hernia with patch: a report of 14cases

Objective To explore the etiology of abdominia incision hernia and treatments of giant incisional hernia of abdominal wall. Methods 14 cases with AGIH treated in our hospital from Oct 2003 to May 2008 were analyzed retrospectively. Results The etiology of abdominia incision hernia were very important,and abdominal longitudinal incision was performed, 10 cases ＞ 67y among 14 cases with incision hernia were 71.42%. Infection of incision and essential conditions( diabetes, chronic cough ,hypoalbum inemia)were also easily induced of incisional hernia. All of them chose the marlex patch. The cases were all cured and no serious postoperative complications. None of cases recurred during a follow up of 3 to 56 months. Conclusion The etiology of AGIH related with longitudinal incision,old ( ＞ 60y)and essential conditions. AGIH were repained with polypropylene mesh. Essential conditions should be treated before operation and abdominal wall should be trained comfortablely. Repairing abdominal incision hernial with artifical patch was a safe and simple operation with minimal postoperation pain.