Hayashida Naoki, Masuda Masahisa, Pearce Yoko, Kuwabara Satoshi
Department of Cardiovascular Surgery, Chiba Cardiovascular Center, Ichihara, Chiba, Japan.
Department of Cardiovascular Surgery, Chiba Medical Center, Chiba, Chiba, Japan.
Ann Vasc Dis. 2014;7(1):17-20. doi: 10.3400/avd.oa.13-00088. Epub 2014 Feb 4.
To evaluate the incidence of wound complications after the retroperitoneal approach for abdominal aortic aneurysm (AAA) repair, and to ascertain the cause of abdominal bulge (AB).
Forty-three patients with AAA repair via the retroperitoneal space were retrospectively investigated. Wound complications and their incidence were studied by chart review. The thickness of the abdominal wall muscle was measured by follow-up computed tomography films. Compound muscle action potentials (CMAPs) of the abdominal rectus muscle were examined for three bulge patients and three non-bulge patients.
Wound hypoesthesia (30%), wound numbness (21%), AB (7%), and wound pain (2%) were found in these patients. The thickness of the abdominal wall muscle was reduced in the incision side. CMAP of abdominal rectus muscle in the incision side disappeared only in AB patients.
(1) Wound hypoesthesia and numbness displayed a high incidence. (2) Atrophy of the abdominal wall muscle in the incision side was found in these patients. (3) The cause of AB is considered to be muscle atrophy induced by denervation injury of an 11th intercostal nerve. (4) To avoid an eleventh intercostal nerve injury must be deemed the most effective method for preventing AB.
评估腹主动脉瘤（AAA）修复术经腹膜后入路后伤口并发症的发生率，并确定腹部膨隆（AB）的原因。
回顾性研究43例行经腹膜后间隙AAA修复术的患者。通过查阅病历研究伤口并发症及其发生率。通过随访计算机断层扫描片测量腹壁肌肉厚度。对3例腹部膨隆患者和3例非膨隆患者检查腹直肌的复合肌肉动作电位（CMAP）。
这些患者中发现伤口感觉减退（30%）、伤口麻木（21%）、AB（7%）和伤口疼痛（2%）。切口侧腹壁肌肉厚度减小。仅在AB患者中，切口侧腹直肌的CMAP消失。
（1）伤口感觉减退和麻木发生率较高。（2）这些患者中发现切口侧腹壁肌肉萎缩。（3）AB的原因被认为是第11肋间神经去神经损伤导致的肌肉萎缩。（4）避免第11肋间神经损伤必须被视为预防AB的最有效方法。
