Bachman Sharon L, Ramaswamy Archana, Ramshaw Bruce J
University of Missouri, Columbia, Missouri, USA.
Am Surg. 2009 Jul;75(7):572-7; discussion 577-8.
A minimally invasive component separation may lead to a dynamic abdominal wall after hernia repair, with reduced complications. We present early results of our patients undergoing this technique. Five patients were selected for open midline repairs; three with chronic infections, one with a prior midline skin graft, and one who desired a primary, tension-free repair. These three males and two females had a mean age of 50.8 +/- 21.1 years and body mass index of 30.9 +/- 6.2. The mean number of previous abdominal operations was 7 +/- 3.4 and previous attempted hernia repairs were 4 +/- 2.7. All patients had a midline laparotomy with lysis of adhesions. An endoscopic component separation was then performed bilaterally. Drains were left in the dissection bed. All patients had the midline closed; four received biologic mesh underlays. Mean operative time was 227 minutes +/- 49. Mean length of stay (LOS) was 9.2 days +/- 3.6. Early median follow-up was 6 months (range 0.25-9). Two patients required postop transfusions, and two patients had mild complications of the midline wound (hematoma, infection). To date, one recurrence was diagnosed by CT scan. Early evaluation of adopting the minimally invasive (MIS) component separation demonstrates minimal complications and good initial outcomes.
微创成分分离术可使疝修补术后腹壁具有动态性，并发症减少。我们展示了接受该技术治疗的患者的早期结果。选择了5例患者进行开放中线修补术；3例有慢性感染，1例曾行中线皮肤移植，1例希望进行初次无张力修补。这3名男性和2名女性的平均年龄为50.8±21.1岁，体重指数为30.9±6.2。既往腹部手术的平均次数为7±3.4次，既往尝试疝修补的次数为4±2.7次。所有患者均行中线剖腹术并松解粘连。然后双侧进行内镜下成分分离术。在分离床留置引流管。所有患者均关闭中线；4例接受生物补片底层植入。平均手术时间为227分钟±49分钟。平均住院时间（LOS）为9.2天±3.6天。早期中位随访时间为6个月（范围0.25 - 9个月）。2例患者术后需要输血，2例患者中线伤口出现轻度并发症（血肿、感染）。迄今为止，通过CT扫描诊断出1例复发。对采用微创（MIS）成分分离术的早期评估显示并发症极少且初步效果良好。
