巨大腹壁疝的修补：补片类型重要吗？

Repair of giant abdominal hernias: does the type of prosthesis matter?

作者信息

Diaz Jose J, Gray Brian W, Dobson Jean M, Grogan Eric L, May Addison K, Miller Richard, Guy Jeffrey, O'Neill Patrick, Morris John A

机构信息

Division of Trauma and Surgical Critical Care, Vanderbilt University Medical Center, Nashville, Tennessee 37212, USA.

出版信息

Am Surg. 2004 May;70(5):396-401; discussion 401-2.

PMID:15156946

Abstract

Closure of the abdominal wall after trauma or major surgery may be difficult due to visceral edema or fascial weakness; thus, the risk of developing a ventral hernia (VH) is high. Commonly, these hernias are repaired using a prosthetic mesh. Complications following mesh repair can develop. We hypothesize that the type of prosthetic material affects outcome. This is a retrospective chart review of patients admitted from 1996 to 2002 undergoing VH (> or = 20 x 10 cm) repair with prosthetic mesh. Data collected included age, sex, and race. Patients were stratified by prosthetic material as follows: Gore-Tex (GR), Marlex + Gore-Tex (MG), Marlex (MR), and Marlex + Vicryl (MV). For the purpose of clinical analysis, the groups were collapsed into subgroups: Gore-Tex exposure (GT) or non-Gore-Tex exposure (NG). Outcome measures were hernia recurrence (HR), wound infection (WI), and fistula formation (FF). Statistical analysis utilized chi2 test and Fisher's exact test. There were 55 VH repairs in 37 patients. The mean age was 43.9 (+/- 16.3), males out-numbered females 22 (59.5%) to 15 (40.5%). The majority of the patients were Caucasian (29; 78.4%). There were 30 trauma patients (81.1%), and 7 general surgery patients (18.9%). The HR for the study (n = 55) was 20 (36.4%), the WI was 17 (30.9%), and the FF was 3 (5.5%). GR group (6; 66.7%) had a significant higher wound IF rate than MR group (8; 26.7%) (Chi P = 0.02, Fisher P = 0.047). All other group comparisons (HR, WI, and FF) were N.S. The Gore-Tex versus non-Gore-Tex subgroup comparison results were as follows: GT (n = 18) had a WI 8 (44.4%), HR 6 (33.3%), and FF 0 (0%). NG (n = 37) had a WI 9 (24.3%), HR 14 (37.8%), and a FF 3 (8.1%). There was a trend toward a higher wound infection in the GT versus NG, but it did not reach statistical significance. We conclude that 1) the wound infection rate was higher in the Gore-Tex versus the Marlex group (Chi P = 0.02, Fisher P = 0.047). Wound infection in the presence of Gore-Tex usually mandates the removal of the mesh resulting in a hernia recurrence. 2) There was a trend toward a higher wound infection in the GT (44.4%) versus NG (24.3%), but it did not reach statistical significance.

摘要

由于内脏水肿或筋膜薄弱，创伤或大手术后腹壁的闭合可能会很困难；因此，发生腹疝（VH）的风险很高。通常，这些疝使用人工补片进行修复。补片修复后可能会出现并发症。我们假设人工材料的类型会影响治疗结果。这是一项对1996年至2002年入院接受人工补片修复VH（≥20×10厘米）的患者进行的回顾性图表分析。收集的数据包括年龄、性别和种族。患者根据人工材料分层如下：戈尔特斯（GR）、聚脂纤维网+戈尔特斯（MG）、聚脂纤维网（MR）和聚脂纤维网+维克瑞（MV）。为了进行临床分析，将这些组合并为亚组：戈尔特斯暴露组（GT）或非戈尔特斯暴露组（NG）。观察指标为疝复发（HR）、伤口感染（WI）和瘘管形成（FF）。统计分析采用卡方检验和费舍尔精确检验。37例患者共进行了55次VH修复。平均年龄为43.9（±16.3）岁，男性22例（59.5%）多于女性15例（40.5%）。大多数患者为白种人（29例；78.4%）。有30例创伤患者（81.1%）和7例普通外科患者（18.9%）。该研究（n = 55）的HR为20例（36.4%），WI为17例（30.9%），FF为3例（5.5%）。GR组（6例；66.7%）的伤口感染率显著高于MR组（8例；26.7%）（卡方检验P = 0.02，费舍尔检验P = 0.047）。所有其他组间比较（HR、WI和FF）均无统计学意义。戈尔特斯与非戈尔特斯亚组比较结果如下：GT组（n = 18）的WI为8例（44.4%），HR为6例（33.3%），FF为0例（0%）。NG组（n = 37）的WI为9例（24.3%），HR为14例（37.8%），FF为3例（8.1%）。GT组与NG组相比有伤口感染率更高的趋势，但未达到统计学意义。我们得出结论：1）戈尔特斯组的伤口感染率高于聚脂纤维网组（卡方检验P = 0.02，费舍尔检验P = 0.047）。戈尔特斯存在时的伤口感染通常需要取出补片，从而导致疝复发。2）GT组（44.4%）与NG组（24.3%）相比有伤口感染率更高的趋势，但未达到统计学意义。