带蒂肠浆肌层片加植皮修复腹壁缺损

目的 研究一种对腹壁缺损行之有效的修复方法。方法 1996年7月-2000年12月，应用带蒂肠浆肌层片加植皮修复腹壁缺损7例，其中前期手术副损伤口致肠瘘4例，肠肿瘤一期手术造瘘局部感染形成缺损2例，肠肿瘤侵犯腹壁1例，全麻下行剖腹探查手术，切除腹壁缺损周围水肿感染组织。切除病变肠管，截取带肠系膜的肠段，沿肠系膜缘对侧剖开肠管，刮除肠粘膜层，将带蒂肠浆肌层片与腹壁缺损边缘缝合，中厚皮片植皮。结果 术后6例腹壁创面Ⅰ期愈合，1例局部感染，植皮部分坏死，经二次植皮愈合；均无肠管吻合口漏发生，经1-2年随访，无腹壁疝或腹内疝发生；正常排便，营养状况明显改善。结论 以带蒂肠浆肌层片修补腹壁，术后局部张力小，血供丰富，成功率高。

PEDICLE GRAFT OF INTESTINE SEROMUSCULAR LAYER AND SKIN GRAFT FOR REPAIR OF ABDOMINAL WALL DEFECT

Objective To explore an effective method to re pair the abdomi nal wall defect. Methods From July 1996 to December 2000, 7 cases with abdom inal wall defect were repaired by pedicle graft of intestine seromuscular layer and skin graft, among them, intestinal fistula caused by previous injury during operation in 4 cases, abdominal wall defect caused by infection after primary fi stulization of colon tumor in 2 cases, abdominal wall invaded by intestinal tumo r in 1 case. Exploratory laparotomy was performed under general anesthesia, the infective and edematous tissue around abdominal wall defect was gotten rid off, and the pathologic intestine was removed. A segment of intestine with mesentery was intercepted, and the intestine along the longitudinal axis offside mesentery was cutted, the mucous layer of intestine was scraped. The intestine seromuscul ar layer was sutured to the margin of abdominal wall defect, and grafted by inte rmediate split thickness skin. Results The abdominal wall wound in 6 cases w ere healed by first intention, but part of grafted skin was necrosed, and it was healed by second skin graft. No intestinal anastomotic leakage was observed in all cases. Followed up 1 to 2 years, there were no abdominal hernia or abdominal internal hernia. All the cases could normally defecate. The nutriture of all ca ses were improved remarkably. Conclusion Pedicle graft of intestine seromusc ular layer is a reliable method to repair abdominal wall defect with low regiona l tension, abundant blood supply and high successful rate.