Department of Digestive Surgery, Amiens University Hospital and Jules Verne University of Picardy, Place Victor Pauchet, 80054 Amiens cedex 01, France.
Hernia. 2011 Oct;15(5):559-65. doi: 10.1007/s10029-011-0832-y. Epub 2011 May 17.
The surgical treatment of large incisional hernias with loss of domain (LIHLD) carries the risk of fascia closure under tension and, thus, abdominal compartment syndrome. We investigated volume measurements as a predictive factor for tension-free fascia closure.
From September 2004 to July 2008, we prospectively included 17 patients with LIHLD. The operation was prepared by a progressive preoperative pneumoperitoneum (PPP) technique known as the Goni Moreno procedure. The patient's age and body mass index (BMI), the incisional hernia's width, length and surface area, and the incisional hernia volume (IHV)/peritoneal volume (PV) ratio <20% were evaluated as predictive factors for tension-free fascia closure. A tension-free closure was defined as a closure in which the use of a surgical device for avoiding postoperative compartment syndrome was not required.
The mean PPP volume introduced was 12.7 ± 4.4 l (range 4.5-19.2) over a period of 11 ± 6 days (range 4-24). The mean width, height and surface area of the incisional hernia after PPP were 11.3 ± 4.7 cm (range 4.5-19), 13.4 ± 7.8 cm (range 4.4-30) and 165 ± 101 cm(2) (range 19-304), respectively. The mean IHV after PPP was 2,374 ± 1,356 cc (range 517-4,802) and the mean abdominal cavity volume was 9,558 ± 4,106 cc (range 4,785-21,782). The mean IHV/PV ratio was 16.3 ± 10.4% (range 4.4-34). In a univariate analysis, the BMI and the IHV/PV ratio were predictive of tension-free fascia closure. In a multivariate analysis, only an IHV/PV ratio <20% was a significant predictive factor.
The IHV/PV ratio is predictive of tension-free fascia closure for hernias or incisional hernias with loss of domain. Simplification of the volumetry method is necessary.
对于存在领域丢失的大型切口疝（LIHLD），外科治疗存在筋膜张力缝合的风险，进而可能导致腹腔间室综合征。我们研究了容量测量作为无张力筋膜闭合的预测因素。
自 2004 年 9 月至 2008 年 7 月，前瞻性纳入 17 例存在 LIHLD 的患者。采用一种称为 Goni Moreno 手术的逐步术前气腹（PPP）技术进行手术准备。评估患者的年龄和体重指数（BMI）、切口疝的宽度、长度和表面积以及切口疝体积（IHV）/腹膜体积（PV）比<20%，作为无张力筋膜闭合的预测因素。无张力闭合定义为无需使用外科装置来避免术后发生间室综合征的闭合。
引入的平均 PPP 体积为 12.7±4.4l（范围 4.5-19.2），持续 11±6 天（范围 4-24）。PPP 后切口疝的平均宽度、高度和表面积分别为 11.3±4.7cm（范围 4.5-19）、13.4±7.8cm（范围 4.4-30）和 165±101cm2（范围 19-304）。PPP 后平均 IHV 为 2374±1356cc（范围 517-4802），平均腹腔容量为 9558±4106cc（范围 4785-21782）。平均 IHV/PV 比为 16.3±10.4%（范围 4.4-34）。在单变量分析中，BMI 和 IHV/PV 比是无张力筋膜闭合的预测因素。在多变量分析中，只有 IHV/PV 比<20%是显著的预测因素。
IHV/PV 比可预测存在领域丢失的疝或切口疝的无张力筋膜闭合。简化体积测量方法是必要的。
