Chen Shuang
Department of Hernia and Abdominal Wall Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2015 Nov;18(11):1071-3.
The aim of this article is to expound on the crossing and influence each other of gastrointestinal surgery and abdominal wall hernia surgery. Although these two departments are independent respectively, but due to the existence of association among anatomy, physiology and pathology, so they are also overlapping. First of all, the abdominal wall and digestive tract are interdependent, and the abdominal wall provides "protection" for gut. In case of large abdominal wall defect, intra-abdominal viscera, breathing, circulation system and spine will change accordingly. In addition, when intra-abdominal pressure increases due to various reasons, laparotomy is an effective way. But laparotomy is not an easy case, but a crisis. One of the most difficult problems is "enteroatmospheric fistulae". Therefore, to avoid serious complications after laparotomy, the concept of planned ventral hernia is proposed. When life safety is threatened by inter-abdominal hypertension, planned abdominal wall hernia is the style to save life. This is a kind of concept of innovation, and is the concrete practice of the theory of damage control surgery. For a planned abdominal wall hernia patient, it is better to wait and watch, and after making a comprehensive assessment, multidisciplinary collaboration mode should be applied to ensure the safety of surgery.
本文旨在阐述胃肠外科与腹壁疝外科的交叉及相互影响。虽然这两个科室各自独立，但由于解剖、生理及病理方面存在关联，所以它们也相互重叠。首先，腹壁与消化道相互依存，腹壁为肠道提供“保护”。一旦腹壁出现大的缺损，腹内脏器、呼吸、循环系统及脊柱都会相应发生改变。此外，当因各种原因导致腹内压升高时，剖腹手术是一种有效的方法。但剖腹手术并非易事，而是一场危机。其中最棘手的问题之一是“肠-腹壁瘘”。因此，为避免剖腹手术后出现严重并发症，提出了计划性腹壁疝的概念。当生命安全受到腹内高压威胁时，计划性腹壁疝是挽救生命的方式。这是一种创新理念，也是损伤控制外科理论的具体实践。对于计划性腹壁疝患者，最好先观察，在进行全面评估后，应采用多学科协作模式以确保手术安全。
