难复性巨大腹壁切口疝患者围手术期的腹腔内压控制

目的 探讨难复性巨大腹壁切口疝治疗中围手术期腹腔内压控制的方法 与效果.方法 对2008年8月至2012年1月诊治的3例难复性巨大腹壁切口疝资料进行回顾性分析.术中切除大网膜,切除体积735～1 130 ml,平均893.3 ml,同时行术中肠内减压.3例患者全部采用Bard composix复合补片及聚丙烯平片行腹腔内修补加腹膜前间隙修补.结果 3例患者手术时间85～140 min,平均113.3 min;术后住院时间11～14 d,平均12.3 d;无呼吸衰竭、腹腔间隔室综合征及切口裂开等严重并发症发生,亦无血清肿发生;切口均一期愈合,顺利恢复出院.结论 采用围手术期综合腹压控制的方法 可以有效降低难复性腹壁巨大腹壁切口疝患者的腹腔内压,减少呼吸衰竭、腹腔间隔室综合征等发生,有利于患者的顺利康复.

Intra-peritoneal pressure control in the irreducible huge incisional hernia of abdominal wall

Objective To explore the methods and effects of perioperative intraperitoneal pressure control on the treatment of irreducible huge incisional hernia.Methods Three cases of patients with irreducible huge incisional hernia diagnosed and treated from August 2008 to January 2012,were analyzed retrospectively.The omentum was removed in the surgery and a volume of 735 to 1 130 ml,with a mean of 893.3 ml.The intraoperative intestinal decompression was applied in parallel.All three cases of patients were applied with the intra-abdominal Bard composix composite patch,the repair with polypropylene flat film line and peritoneum gap repair.Results The operative time was 85 to 140 minutes with a mean of 113.3 minutes in the three cases of patients.The hospital stay after operation was 11 to 14 days,a mean of 12.3 days;Respiratory failure,abdominal compartment syndrome and serious complications such as wound dehiscence occurred,nor serum swelling occurred;and incision healed.The patients were recovered and discharged.Conclusions Perioperative abdominal pressure control can reduce intra-abdominal pressure in the patients with irreducible huge abdominal incisional hernia and respiratory failure and the occurrence of abdominal compartment syndrome could be eliminated,which could be beneficial for rehabilitation of patients.