van't Riet Martijne T, De Vos Van Steenwijk Peggy J, Bonjer H Jaap, Steyerberg Ewout W, Jeekel Johannes
Department of Surgery, Erasmus University Medical Center, Rotterdam-Dijkzigt, Rotterdam, The Netherlands.
Am Surg. 2004 Apr;70(4):281-6.
The true incidence of incisional hernia after wound dehiscence repair remains unclear because thorough long-term follow-up studies are not available. Medical records of all patients who had undergone wound dehiscence repair between January 1985 and January 1999 at the Erasmus University Medical Center Rotterdam were reviewed. Long-term follow-up was performed by physical examination of all patients in February 2001. One hundred sixty-eight patients underwent wound dehiscence repair. Of those, 42 patients (25%) died within 60 days after surgery. During a median follow-up of 37 months (range, 3-146 months), 55 of the remaining 126 patients developed an incisional hernia. The cumulative incidence of incisional hernia was 69 per cent at 10 years. Significant independent risk factors were aneurysm of the abdominal aorta (10-year cumulative incidence of 84%, P = 0.02) and severe dehiscence with evisceration (10-year cumulative incidence of 78%, P = 0.01). Wound dehiscence repair by interrupted sutures had no better outcome than repair by continuous sutures. Suture material did not influence incidence of incisional hernia. Incisional hernia develops in the majority of patients after wound dehiscence repair, regardless of suture material or technique. Aneurysm of the abdominal aorta and severe dehiscence with evisceration predispose to incisional hernia.
由于缺乏全面的长期随访研究，伤口裂开修复术后切口疝的真实发病率仍不明确。我们回顾了1985年1月至1999年1月期间在鹿特丹伊拉斯姆斯大学医学中心接受伤口裂开修复术的所有患者的病历。2001年2月对所有患者进行了体格检查以进行长期随访。168例患者接受了伤口裂开修复术。其中，42例患者（25%）在术后60天内死亡。在其余126例患者的中位随访期为37个月（范围3 - 146个月）期间，有55例发生了切口疝。切口疝的10年累积发病率为69%。显著的独立危险因素是腹主动脉瘤（10年累积发病率为84%，P = 0.02）和伴有脏器脱出的严重裂开（10年累积发病率为78%，P = 0.01）。间断缝合进行伤口裂开修复的效果并不优于连续缝合。缝合材料不影响切口疝的发生率。无论缝合材料或技术如何，大多数伤口裂开修复术后的患者都会发生切口疝。腹主动脉瘤和伴有脏器脱出的严重裂开易引发切口疝。
