Mohan R, Hui-Chou H G, Wang H D, Nam A J, Magarakis M, Mundinger G S, Brown E N, Kelamis A J, Christy M R, Rodriguez E D
Division of Plastic, Reconstructive and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD, USA.
Hernia. 2015 Apr;19(2):313-21. doi: 10.1007/s10029-014-1313-x. Epub 2014 Sep 24.
Abdominal compartment syndrome (ACS) is a severe complication of ventral hernia repair. The aims of this study were to investigate the effects of intra-abdominal pressure on the physiologic changes of abdominal wall reconstruction and component separation in a porcine model.
Ventral hernia repair (VHR) was simulated by abdominal fascial imbrication of a 10 × 15 cm defect in 45 Yorkshire pigs assigned to five experimental groups. ACS was simulated by a Stryker endoscopy insufflator with intra-abdominal pressure elevated to 20 mmHg in two groups. Component separation was performed in one of these groups and in one group without ACS. Physiological parameters were measured before and after the procedures and monitored for 4 h. The animals were euthanized for histologic analysis of organ damage.
VHR led to an increase in intra-abdominal pressure, bladder pressure, and central venous pressure by an average of 14.89, 13.93, and 14.69 mmHg (p < 0.001) in all animals. Component separation was performed in 25 animals and the three pressures reduced by 9.11, 8.00, 7.89 mmHg (p < 0.001). ACS correlated with higher percentages of large and small bowel necrosis compared to groups without abdominal compartment syndrome.
The results confirm that primary repair of large abdominal wall defects leads to increased intra-abdominal pressure, which can be reduced with component separation. In animals with ACS, component separation may reduce the risk of organ damage. Central venous pressure, bladder pressure, and other physiologic parameters accurately correlated with elevated intra-abdominal pressure and may have utility as markers for diagnosis of ACS.
腹腔间隔室综合征（ACS）是腹疝修补术的一种严重并发症。本研究旨在探讨猪模型中腹内压对腹壁重建和成分分离生理变化的影响。
将45只约克夏猪分配到五个实验组，通过对10×15 cm的缺损进行腹部筋膜叠瓦式缝合模拟腹疝修补术（VHR）。两组使用史赛克内镜气腹机将腹内压升高至20 mmHg来模拟ACS。在其中一组和一组未发生ACS的组中进行成分分离。在手术前后测量生理参数，并监测4小时。对动物实施安乐死以进行器官损伤的组织学分析。
在所有动物中，VHR导致腹内压、膀胱压和中心静脉压平均分别升高14.89、13.93和14.69 mmHg（p<0.001）。对25只动物进行了成分分离，三种压力分别降低了9.11、8.00、7.89 mmHg（p<0.001）。与无腹腔间隔室综合征的组相比，ACS与更高比例的大肠和小肠坏死相关。
结果证实，大面积腹壁缺损的一期修复会导致腹内压升高，成分分离可降低腹内压。在患有ACS的动物中，成分分离可能会降低器官损伤的风险。中心静脉压、膀胱压和其他生理参数与腹内压升高准确相关，可能作为诊断ACS的标志物。
