腹壁切口疝诊疗理念与技术革新

Innovation in diagnosis and treatment concepts and technologies for abdominal wall incision hernia

  • 摘要: 《腹壁切口疝诊疗指南(2024版)》(以下简称《切口疝指南》)以牛津大学循证医学中心证据评价标准推进腹壁功能重建,提出3项革新:(1)立体缝合。腹腔镜倒刺线或鱼骨线连续缝合关闭缺损,使中大型切口疝复发率<8%。(2)转化治疗。对巨大切口疝伴腹壁功能不全(疝囊容积比>20%),采用肉毒素注射联合渐进性人工气腹突破手术禁忌证,使腹壁关闭率提升40%,术后腹腔间室综合征发生风险<5%。(3)复杂腹壁状态评估。从患者全身因素、腹壁相关因素、手术部位相关因素、疝相关因素4个维度进行评估,经多学科团队及杂交手术个体化干预。《切口疝指南》确立疝囊容积比20%为腹壁功能不全阈值,标志着疝与腹壁外科迈入解剖‑功能整合时代。笔者基于《切口疝指南》创新点,针对立体缝合的技术要点、转化治疗的策略实施,以及复杂腹壁状态的个体化处理,详述腹壁切口疝诊疗理念与技术革新内容,旨在推动其临床应用,并指导临床实践。

     

    Abstract: The Guidelines for Diagnosis and Treatment of Abdominal Wall Incision Hernia (2024 Edition) (hereinafter referred to as the Incisional Hernia Guidelines) promotes abdominal wall function reconstruction based on the evidence evaluation criteria of the Oxford University Evidence‑Based Medicine Center, proposes three innovations: (1) Three‑dimensional suturing. Laparoscopic continuous suturing with barbed or quill sutures to close defects, reducing recurrence rates of medium‑to‑large hernias to <8%. (2) Conversion therapy. For giant incision hernia with abdominal wall insufficiency (hernia sac volume ratio >20%), botulinum toxin injection combined with progressive pneumoperitoneum can overcome surgical contraindications, results in increasing defect closure rates by 40% with <5% risk of postoperative abdominal compartment syndrome. (3) Complex abdominal wall evaluation. Evaluates complexity across four dimensions, including systemic factors, abdominal wall related factors, surgical site related factors, and hernia related factors, and individualized intervention is carried out through multidisciplinary teams and hybrid surgery. The Incisional Hernia Guidelines establish a hernia sac volume ratio of 20% as the threshold for loss of abdominal domain, marking the entry of hernia and abdominal wall surgery into an anatomy-function integration era. Based on the innovative points of the "Incisional Hernia Guidelines", the author elaborates on the diagnostic and treatment concepts and technological innovations of abdo-minal incisional hernia, focusing on the technical points of three-dimensional suturing, the imple-mentation of conversion therapy strategies, and individualized treatment of complex abdominal wall evaluation, with the aim of promoting its clinical application and guiding clinical practice.

     

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