主动减容手术在巨大腹壁疝治疗中的应用和进展

Application and progress of initiative content reduction surgery in the treatment of large ventral hernia

  • 摘要: 目前国内腹部手术例数逐年提高,伴随而来的是术后切口疝、造口旁疝患者的增加,其原因主要是腹部手术切口或造瘘口破坏腹壁正常肌肉腱膜组织的结构,以及肥胖、营养不良、腹腔积液、糖尿病、感染等各种因素导致伤口愈合不良,使得切口疝高发。腹部手术后发生的腹壁切口疝约占腹壁疝的80%,且此类切口疝及其他腹壁疝如未经规范治疗容易进展成为巨大腹壁疝。手术是巨大腹壁疝唯一有效的治疗方法。然而,此类疝修补手术对外科医师是一个极大的挑战。在临床实践中,手术切除巨大疝囊后完全还纳长期脱入疝囊内的内容物,会造成术后腹腔容积减小,腹内压升高,导致腹腔内高压,甚至发生术后腹腔间室综合征(ACS)。巨大腹壁疝术后的腹内压升高和ACS的发生,已经引起广大临床医师的重视。笔者在临床实践中发现部分巨大腹壁疝患者行术中减容可有效减低术后腹内压,从而大大降低腹腔内高压和ACS发生的可能性。目前越来越多的巨大腹壁疝患者接受了腹壁疝修补手术联合减容手术,但仍缺少大样本的临床和循证医学研究。因此,尚需进行大样本、多中心的前瞻性临床研究,旨在为减容手术提供临床治疗策略,为临床研究和应用提供更多基础。

     

    Abstract: Currently, the number of abdominal surgery has gradually increased, accompanied by the increasing of ventral hernia and parastomal hernia patients. The main reason is abdominal incision or abdominal stoma destroying the normal abdominal muscle fascia, as well as obesity, malnutrition, ascites, diabetes, infections leading to poor wound healing. The incidence of abdominal wall incisional hernia after abdominal surgery accounts for about 80% of ventral hernia. These incisional hernias and some other ventral hernias may easily become large ventral hernia without the standard treatment. Surgery is the only effective treatment for large ventral hernia. However, such hernia repair for surgeons is a great challenge. In clinical practice, after removing the huge sac and completely resetting the contents of the hernia sac can lead to decreasing of intraperitoneal volume and increasing of intraabdominal pressure, or even lead to occurrence of abdominal compartment syndrome (ACS). The increasing of intraabdominal pressure and occurrence of ACS has aroused the attention of clinicians after large ventral hernia operation. Some content reduction operation in the process of large ventral hernia surgery can effectively reduce postoperative intraabdominal pressure, occurrence of intraabdominal hypertension and ACS. More and more patients with large ventral hernia underwent the abdominal content reduction surgery combined with hernia repair. But there is still lack of evidencebased medical researches on large simples. Therefore, it still needs multicenter prospective clinical study on large samples to provide clinical treatment strategies for the volume reduction surgery and more base for further researches and clinical applications.

     

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