Höer J, Lawong G, Klinge U, Schumpelick V
Chirurgische Universitätsklinik der RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen.
Chirurg. 2002 May;73(5):474-80. doi: 10.1007/s00104-002-0425-5.
Incisional hernia formation is one of the most frequent complications in visceral surgery requiring reoperation. Risk factors for incisional hernia formation and preventive strategies are not clearly defined.
In a retrospective study including 2983 patients over a 10-year period, the influence of demographic data, pre-, intra- and postoperative risk factors for incisional hernia development were evaluated. From the subgroups medical history, medication, laboratory values, indication, surgical technique, course of operation, postoperative course and wound healing, altogether 43 parameters were analysed. Statistical evaluation was performed using the chi 2-test according to Pearson, and binary logistic regression analysis.
The mean incisional hernia incidence in the study was 4.3%. In the mean follow-up period of 21.1 months, the incisional hernia incidence was calculated at 9.8% using the Kaplan-Meier estimate; for a 10-year period it reached 18.7%. The study revealed that 31.5% of all incisional hernias developed in the first 6 months after the operation, 54.4% after 12 months, 74.8% after 2 years and 88.9% after 5 years. Significant demographic factors influencing incisional hernia incidence were age (> 45 years) and male gender. The preoperative factors anaemia (Hb < 100 g/l) and BMI > 25, the intraoperative factors recurrent incision and previous laparotomy, and the postoperative factors catecholamin-therapy and disturbed wound healing were of significant influence.
The calculated incisional hernia incidence for a 10 year period of almost 20% and the manifestation of 50% of all hernias more than 12 months after the operation, underline the necessity to intensify surgical research in the field of laparotomy healing. In comparison to demographic and endogenous risk factors, the surgical technique has less influence on laparotomy healing. Measures to ameliorate tissue perfusin seem to exert a positive influence on incisional hernia incidence.
切口疝形成是需要再次手术的内脏外科最常见的并发症之一。切口疝形成的危险因素和预防策略尚未明确界定。
在一项为期10年、纳入2983例患者的回顾性研究中，评估了人口统计学数据、切口疝发生的术前、术中和术后危险因素的影响。从病史、用药情况、实验室检查值、手术指征、手术技术、手术过程、术后病程和伤口愈合等亚组中，共分析了43个参数。采用Pearson卡方检验和二元逻辑回归分析进行统计学评估。
该研究中切口疝的平均发生率为4.3%。在平均21.1个月的随访期内，采用Kaplan-Meier估计法计算切口疝发生率为9.8%；10年时达到18.7%。研究显示，所有切口疝中有31.5%在术后前6个月发生，54.4%在12个月后发生，74.8%在2年后发生，88.9%在5年后发生。影响切口疝发生率的显著人口统计学因素为年龄（>45岁）和男性。术前因素贫血（血红蛋白<100g/L）和体重指数>25，术中因素切口复发和既往剖腹手术，以及术后因素儿茶酚胺治疗和伤口愈合不良均有显著影响。
计算得出的10年切口疝发生率近20%，且所有疝中有50%在术后12个月以上出现，这突出了加强剖腹手术愈合领域外科研究的必要性。与人口统计学和内源性危险因素相比，手术技术对剖腹手术愈合的影响较小。改善组织灌注的措施似乎对切口疝发生率有积极影响。
