改良式覆盖技术修复复杂切口疝：单中心大样本评估。
Modified onlay technique for the repair of the more complicated incisional hernias: single-centre evaluation of a large cohort.
机构信息
Department of Surgery, Medical Centre Alkmaar, Wilhelminalaan 12, 1815 JD Alkmaar, The Netherlands.
出版信息
Hernia. 2010 Aug;14(4):369-74. doi: 10.1007/s10029-010-0646-3. Epub 2010 Mar 14.
BACKGROUND
The repair of incisional hernias remains a challenge for the general surgeon. Indications for surgery are severe bowel obstruction, as well as aesthetic problems. There are various surgical methods to correct these hernias, with varying results. However, the gold standard has not yet been found. Both laparoscopic repair and the component separation technique (CTS) have proven to be acceptable techniques; however, they are not always suitable for resolving the more complicated abdominal wall defects, i.e. after open-abdomen treatment or fascial necrosis. In our hospital, we developed a new onlay technique which we have evaluated in the following research.
PATIENTS AND METHODS
During a period of 10 years (1996-2007), 101 patients with an incisional hernia were corrected with the new onlay technique. A Marlex mesh of dimensions at least 10 x 20 cm was used, overlapping the fascia by at least 5 cm on each side. This mesh was stapled onto the fascia with skin staples. Of the 101 patients, there were 45 men and 56 women, with a mean age of 55 years. Nine patients died and 13 were lost during follow-up. Of the remaining 79 patients, eight refused to participate. The mean follow-up time was 64 months (normal distribution, standard deviation [SD] 34 months). This cohort of 101 patients was studied retrospectively.
RESULTS
Seventy-one of the 101 patients were evaluated at our out-patient clinic. For 24 patients (25%), the operation was for a recurrence after an incisional hernia correction in the past. Twenty-one patients (20%) had an open-abdomen treatment in their medical history. The surgical procedure was technically possible in all patients and the mean operation time was 63 min. The median admission time was 4.5 days (quartiles 3-6.25). The mean follow-up time was 64 months (SD 35 months). A seroma was reported in 27 of 101 patients (27%) and a wound infection in 22 patients (21%), of which seven patients had to be re-operated. Only if a patient was evaluated at our out-patient clinic could reherniation have been scored; this occurred in 11 of 71 patients (16%).
CONCLUSION
This technique is an effective and simple procedure to correct incisional hernias with acceptable complication rates and is feasible even in the more complicated hernias.
背景
切口疝的修复仍然是普通外科医生面临的挑战。手术指征为严重的肠梗阻，以及美容问题。有各种手术方法可以纠正这些疝，结果各不相同。然而，尚未找到金标准。腹腔镜修补术和组件分离技术（CTS）已被证明是可接受的技术；然而，它们并不总是适用于解决更复杂的腹壁缺损，即在腹部开放治疗或筋膜坏死之后。在我们医院，我们开发了一种新的覆盖技术，我们在以下研究中对其进行了评估。
患者和方法
在 10 年期间（1996-2007 年），用新的覆盖技术纠正了 101 例切口疝患者。使用至少 10x20cm 的 Marlex 网片，每侧至少重叠筋膜 5cm。该网片用皮肤钉固定在筋膜上。101 例患者中，男 45 例，女 56 例，平均年龄 55 岁。9 例死亡，13 例随访时丢失。在其余 79 例患者中，8 例拒绝参与。平均随访时间为 64 个月（正态分布，标准差[SD]为 34 个月）。对这 101 例患者进行了回顾性研究。
结果
101 例患者中有 71 例在我院门诊进行了评估。24 例（25%）为既往切口疝修补术后复发。21 例（20%）患者有腹部开放治疗史。所有患者的手术均可行，平均手术时间为 63 分钟。中位住院时间为 4.5 天（四分位距 3-6.25）。平均随访时间为 64 个月（SD 35 个月）。101 例患者中有 27 例（27%）报告有血清肿，22 例（21%）有伤口感染，其中 7 例需要再次手术。只有在门诊评估的患者才能对复发进行评分；71 例患者中有 11 例（16%）发生这种情况。
结论
该技术是一种有效且简单的方法，可以纠正切口疝，并发症发生率可接受，即使在更复杂的疝中也可行。
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