Jargon D, Friebe V, Hopt U T, Obermaier R
Abteilung für Allgemein- und Viszeralchirurgie, Chirurgische Universitätsklinik der Albert-Ludwigs-Universität, Freiburg.
Zentralbl Chir. 2008 Sep;133(5):453-7. doi: 10.1055/s-2008-1076961. Epub 2008 Oct 15.
Incisional hernia is a late complication of laparotomy for which an evidence-based prohylactic approach is still lacking. Postoperatively, incisional hernias occur because of multiple factors. Preoperative comorbidities belong to these risk factors. A risk reduction related to concomitant diseases mostly does not succeed. There is a range of studies comparing the techniques of surgical wound closure. A consensus of these is that a running suture of the fascia with slowly absorbable or non-absorbable sutures results in the lowest incidence of incisional hernias. A one-cm distance between the stitches and a minimal distance of one cm to the fascial margin as well as a 4:1 suture length to wound length ratio are still valid principles. In any case, solely optimising the surgical technique of the abdominal wall closure is not able to reduce the incidence of incisional hernias. Prevention of postoperative complications by adequate pain management, respiratory training and early mobilisation are procedures to reduce the incidence of incisional hernias. However, systematic studies are lacking. To avoid an incisional hernia, only a practical approach remains which, however, does not meet the requirements of evidence-based medicine.
切口疝是剖腹手术的一种晚期并发症，目前仍缺乏基于证据的预防性方法。术后，切口疝的发生是由多种因素导致的。术前合并症属于这些风险因素。降低与伴发疾病相关的风险大多难以成功。有一系列研究比较了手术伤口缝合技术。这些研究的共识是，使用可缓慢吸收或不可吸收缝线连续缝合筋膜可使切口疝的发生率最低。缝线间距为1厘米、距筋膜边缘至少1厘米以及缝线长度与伤口长度之比为4:1仍然是有效的原则。无论如何，仅优化腹壁闭合的手术技术并不能降低切口疝的发生率。通过适当的疼痛管理、呼吸训练和早期活动来预防术后并发症是降低切口疝发生率的措施。然而，缺乏系统性研究。为避免切口疝，只剩下一种实用方法，但这不符合循证医学的要求。
