Waldhausen J H, Davies L
Department of Surgery, Children's Hospital and Regional Medical Center, University of Washington School of Medicine, Seattle 80105-0371, USA.
J Am Coll Surg. 2000 Jun;190(6):688-91. doi: 10.1016/s1072-7515(00)00284-2.
Fascial dehiscence is uncommon in children but can have serious consequences when it occurs. There are multiple risk factors for fascial dehiscence, including the type of incision used. Pediatric surgeons often use a supraumbilical transverse incision particularly in infants because of the access this incision provides to the entire abdomen. This article details the experience with fascial wound dehiscence at a large tertiary children's hospital and focuses on problems with the types of incision used.
This is a retrospective review of 2,785 intraabdominal operations performed over a 5-year period at Children's Hospital and Regional Medical Center in Seattle. Risk factors for dehiscence were reviewed for each case of fascial dehiscence. Statistical analysis using chi-square was used to examine for differences in complication rates between transverse and vertical incisions.
In this series, 2,442 children (88%) had transverse incisions and 343 (12%) had vertical incisions. Twelve children had abdominal fascial dehiscence post-operatively. Six cases involved transverse incisions and six involved vertical incisions. Five of the children suffered evisceration. One child died as a direct result of the dehiscence. There were multiple risk factors for dehiscence in 10 of the 12 children. Vertical incisions were found to be much more likely to dehisce than were transverse incisions, especially in children under 1 year of age (p < 0.001).
Vertical incisions are more apt to dehisce than transverse incisions in children, particularly babies. We recommend the use of transverse incisions whenever possible in babies less than 1 year of age, especially when other risk factors for dehiscence are present.
筋膜裂开在儿童中并不常见，但一旦发生可能会产生严重后果。筋膜裂开有多种危险因素，包括所使用的切口类型。小儿外科医生通常采用脐上横向切口，尤其是在婴儿中，因为这种切口能够提供进入整个腹部的通道。本文详细介绍了一家大型三级儿童医院筋膜伤口裂开的情况，并重点关注所使用切口类型的问题。
这是一项对西雅图儿童医院及区域医疗中心5年内进行的2785例腹腔内手术的回顾性研究。对每例筋膜裂开病例的裂开危险因素进行了回顾。使用卡方检验进行统计分析，以检查横向和纵向切口之间并发症发生率的差异。
在本系列中，2442名儿童（88%）采用了横向切口，343名儿童（12%）采用了纵向切口。12名儿童术后出现腹部筋膜裂开。6例涉及横向切口，6例涉及纵向切口。5名儿童发生了脏器脱出。1名儿童因裂开直接死亡。12名儿童中有10名存在多种裂开危险因素。发现纵向切口比横向切口更容易裂开，尤其是在1岁以下的儿童中（p < 0.001）。
在儿童，尤其是婴儿中，纵向切口比横向切口更容易裂开。我们建议在1岁以下的婴儿中尽可能使用横向切口，尤其是在存在其他裂开危险因素时。
