Pantelis D, Jafari A, Vilz T O, Schäfer N, Kalff J C, Kaminski M
Klinik und Poliklinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Universität Bonn, Sigmund- Freud-Str. 25, 53105, Bonn, Deutschland.
Chirurg. 2012 Jun;83(6):555-60. doi: 10.1007/s00104-011-2171-z.
The repair of complicated abdominal hernias remains a challenging problem. The components separation technique introduced by Ramirez et al. is an increasingly popular method for autogenous reconstruction of the abdominal wall, especially in combination with epifascial mesh reinforcement.
In a retrospective study carried out at a university hospital, 40 consecutive patients between 2002 and 2010 were analyzed.
Indications for abdominal reconstruction were fascial defects after secondary healed laparostoma in 22 patients (55%) and fascial defects combined with colostomy reversal after a Hartmann procedure in 10 patients (25%). A total of 9 wound infections (22.5%) occurred and 10 hernia recurrences (10/36 patients) were identified in the follow-up (mean 3.8 years, range 1-9 years). Reconstructions with mesh reinforcement resulted in a lower rate of recurrences (19% with mesh vs 40% without mesh).
The components separation technique, in combination with epifascial mesh reinforcement as appropriate, is the procedure of choice for most complicated abdominal wall hernias. Therefore, each visceral surgeon should be able to perform this method. Recurrence rates depend on the underlying disease of the patient and the complexity of the hernia.
复杂腹壁疝的修复仍然是一个具有挑战性的问题。拉米雷斯等人引入的成分分离技术是一种越来越流行的自体腹壁重建方法，特别是与筋膜上补片加强相结合时。
在一家大学医院进行的一项回顾性研究中，对2002年至2010年期间连续的40例患者进行了分析。
腹壁重建的指征包括22例患者（55%）继发愈合的剖腹术后筋膜缺损，以及10例患者（25%）哈特曼手术后筋膜缺损合并结肠造口回纳。随访期间（平均3.8年，范围1 - 9年）共发生9例伤口感染（22.5%），并发现10例疝复发（10/36例患者）。使用补片加强的重建术复发率较低（使用补片为19%，未使用补片为40%）。
成分分离技术，酌情与筋膜上补片加强相结合，是大多数复杂腹壁疝的首选手术方法。因此，每位普通外科医生都应能够实施该方法。复发率取决于患者的基础疾病和疝的复杂性。
