Cheng Amy W, Abbas Maher A, Tejirian Talar
Kaiser Permanente, Los Angeles, California, USA.
Am Surg. 2013 Oct;79(10):992-6.
The use of biologic mesh in abdominal wall operations has gained popularity despite a paucity of outcome data. We aimed to review the experience of a large healthcare organization with Permacol™. A retrospective study was conducted of patients who underwent abdominal hernia repair with Permacol™ in 14 Southern California hospitals. One hundred ninety-five patients were analyzed over a 4-year period. Operations included ventral/incisional hernia repairs, ostomy closures, parastomal hernia repairs, and inguinal hernia repairs. In 50 per cent of the patients, Permacol™ was used to reinforce a primary fascial repair and in 50 per cent as a fascial bridge. The overall complication rate was 39.5 per cent. The complication rate was higher in patients with infected versus clean wounds, body mass index (BMI) 40 kg/m(2) or greater versus BMI less than 40 kg/m(2), in patients with prior mesh repair, and when mesh was used as a fascial bridge. With a mean follow-up of 2.1 years, morbid obesity was associated with a higher recurrence. To date this is the largest study on the use of Permacol™ in abdominal wall hernia repair. In our patient population undergoing heterogeneous operations with a majority of wounds as Class II or higher, use of Permacol™ did not eliminate wound morbidity or prevent recurrence, especially in morbidly obese patients.
尽管缺乏疗效数据，但生物补片在腹壁手术中的应用已越来越普遍。我们旨在回顾一家大型医疗机构使用Permacol™的经验。对在南加州14家医院接受Permacol™腹壁疝修补术的患者进行了一项回顾性研究。在4年期间对195例患者进行了分析。手术包括腹侧/切口疝修补术、造口关闭术、造口旁疝修补术和腹股沟疝修补术。50%的患者使用Permacol™加强初次筋膜修复，50%作为筋膜桥。总体并发症发生率为39.5%。感染伤口患者的并发症发生率高于清洁伤口患者，体重指数（BMI）≥40kg/m²的患者高于BMI＜40kg/m²的患者，既往有补片修补史的患者，以及使用补片作为筋膜桥时。平均随访2.1年，病态肥胖与较高的复发率相关。迄今为止，这是关于Permacol™在腹壁疝修补术中应用的最大规模研究。在我们接受多种手术且大多数伤口为Ⅱ类或更高等级的患者群体中，使用Permacol™并不能消除伤口并发症或预防复发，尤其是在病态肥胖患者中。
