Lien Samuel C, Hu Yaxi, Wollstein Adi, Franz Michael G, Patel Shaun P, Kuzon William M, Urbanchek Melanie G
Section of Plastic Surgery, University of Washington Medical Center, Seattle, WA.
Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI.
Surgery. 2015 Jul;158(1):278-88. doi: 10.1016/j.surg.2015.01.023. Epub 2015 Mar 25.
Incisional hernias are a complication in 10% of all open abdominal operations and can result in substantial morbidity. The purpose of this study was to determine whether inhibiting abdominal muscle contraction influences incisional hernia formation during the fascial healing after laparotomy. We hypothesized that decreasing the deformation of the abdominal musculature would decrease the size or occurrence of an incisional hernia.
Using an established rat model for incisional hernia, a laparotomy through the linea alba was closed with 1 mid-incision, fast-absorbing suture. Three groups were compared: a sham group (sham; n = 6) received no laparotomy, and the saline hernia (SH; n = 6) and Botox hernia (BH; n = 6) groups were treated once with equal volumes of saline or botulinum toxin (Botox, Allergan) before the incomplete laparotomy closure. On postoperative day 14, the abdominal wall was examined for herniation and adhesions, and contractile forces were measured for abdominal wall muscles.
No hernias developed in the sham rats. Rostral hernias developed in all SH and BH rats. Caudal hernias developed in all SH rats, but in only 50% of the BH rats. Rostral hernias in the BH group were 35% shorter and 43% narrower compared with those in the SH group (P < .05). The BH group had weaker abdominal muscles compared with the sham and SH groups (P < .05).
In our rat model, partial paralysis of abdominal muscles decreases the number and size of incisional hernias. These results suggest that contractions of the abdominal wall muscle play a role in the pathophysiology of the formation of incisional hernias.
切口疝是所有开腹手术中10%的患者会出现的并发症，可导致严重的发病率。本研究的目的是确定抑制腹部肌肉收缩是否会影响剖腹手术后筋膜愈合过程中切口疝的形成。我们假设减少腹部肌肉组织的变形会减少切口疝的大小或发生率。
使用已建立的切口疝大鼠模型，通过白线进行剖腹手术，用1根中切口、快速吸收缝线关闭。比较三组：假手术组（假手术；n = 6）未进行剖腹手术，盐水疝组（SH；n = 6）和肉毒杆菌毒素疝组（BH；n = 6）在不完全关闭剖腹手术前用等量的盐水或肉毒杆菌毒素（肉毒杆菌毒素，艾尔建公司）治疗一次。术后第14天，检查腹壁有无疝形成和粘连，并测量腹壁肌肉的收缩力。
假手术大鼠未发生疝。所有SH组和BH组大鼠均发生头侧疝。所有SH组大鼠均发生尾侧疝，但BH组大鼠仅50%发生尾侧疝。与SH组相比，BH组头侧疝短35%，窄43%（P <.05）。与假手术组和SH组相比，BH组腹肌较弱（P <.05）。
在我们的大鼠模型中，腹部肌肉部分麻痹可减少切口疝的数量和大小。这些结果表明腹壁肌肉收缩在切口疝形成的病理生理学中起作用。
