Ammaturo C, Bassi G
Hospital S.M. di Loreto Nuovo, Via Poggiomarino 15, 80040, San Gennaro Ves, Napoli, Italy.
Hernia. 2005 Dec;9(4):316-21. doi: 10.1007/s10029-005-0016-8. Epub 2005 Sep 20.
Current classifications of incisional hernias are often not suitable. The aim of our study was to demonstrate that it is important to consider not only the wall defect surface (WDS) but also the total surface of the anterior abdominal wall (SAW) and the ratio between SAW/WDS). Twenty-three patients affected by > 10 cm size incisional hernias were examined for anthropometric analyses. The SAW, the WDS and the ratio SAW/WDS were calculated. All of the 23 patients were operated on 13 patients were treated with the Rives technique using a polypropylene mesh while the remaning ten patients had an intraperitoneal Parietex Composite mesh (PC). The two groups were compared for post-operative pain (with VAS) and intra-abdominal pressure (IAP) 48 h after the operation: bladder pressure, length of the procedure, average hospital stay and return to work were calculated. In the Rives group, WDS being equal, the higher IAP values were, the lower was the ratio SAW/WDS; furthermore, SAW/WDS ratio being equal, IAP values were low in cases where intraperitoneal mesh was used. Post-operative pain, measured with VAS, was critical when there was a low SAW/WDS ratio and a high IAP. In our experience, it is possible to predict a strong abdominal wall tension if the SAW/WDA ratio is below 15 mmHg. In these cases it is advisable to use a technique requiring the use of an intraperitoneal mesh. Our experience with PC was so positive that it is used in our department for all cases where an intraperitoneal mesh is required. At present, our proposal is that the SAW/WDS ratio is to be considered as a new parameter in current classifications of incisional hernias.
目前切口疝的分类方法往往并不适用。我们研究的目的是证明，不仅要考虑腹壁缺损面积（WDS），还要考虑前腹壁的总面积（SAW）以及SAW/WDS的比值，这一点很重要。对23例患有大于10厘米大小切口疝的患者进行人体测量分析。计算SAW、WDS以及SAW/WDS的比值。所有23例患者均接受了手术，13例患者采用聚丙烯网片的Rives技术治疗，其余10例患者使用了腹腔内Parietex复合网片（PC）。比较两组患者术后48小时的疼痛情况（采用视觉模拟评分法VAS）和腹内压（IAP）：计算膀胱压力、手术时长、平均住院时间和恢复工作时间。在Rives组中，在WDS相同的情况下，IAP值越高，SAW/WDS的比值越低；此外，在SAW/WDS比值相同的情况下，使用腹腔内网片的病例IAP值较低。当SAW/WDS比值较低且IAP较高时，采用VAS测量的术后疼痛较为严重。根据我们的经验，如果SAW/WDA比值低于15 mmHg，则有可能预测腹壁张力较大。在这些情况下，建议使用需要使用腹腔内网片的技术。我们使用PC的经验非常积极，以至于在我们科室，对于所有需要使用腹腔内网片的病例都使用它。目前，我们建议将SAW/WDS比值作为当前切口疝分类中的一个新参数。
