Alam N N, Narang S K, Pathak S, Daniels I R, Smart N J
Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon and Exeter Hospital, Barrack Road, Exeter, Devon, EX2 5DW, England, UK.
Hernia. 2016 Apr;20(2):191-9. doi: 10.1007/s10029-016-1463-0. Epub 2016 Feb 9.
To systematically review the available literature regarding methods for abdominal wall expansion and compare the outcome of primary fascial closure rates.
A systematic search of Pubmed and Embase databases was conducted using the search terms "Abdominal wall hernia", "ventral hernia", "midline hernia", "Botulinum toxin", "botox", "dysport", "progressive preoperative pneumoperitoneum", and "tissue expanders". Study quality was assessed using the Methodological Index for Non-Randomised Studies.
21 of the 105 studies identified met the inclusion criteria. Progressive preoperative pneumoperitoneum (PPP) was performed in 269 patients across 15 studies with primary fascial closure being achieved in 226 (84%). 16 patients had a recurrence (7.2%) and the complication rate was 12% with 2 reported mortalities. There were 4 studies with 14 patients in total undergoing abdominal wall expansion using tissue expanders with a fascial closure rate of 92.9% (n = 13). A recurrence rate of 10.0% (n = 1) was reported with 1 complication and no mortalities. Follow up ranged from 3 to 36 months across the studies. There were 2 studies reporting the use of botulinum toxin with 29 patients in total. A primary fascial closure rate of 100% (n = 29) was demonstrated although a combination of techniques including component separation and Rives-Stoppa repair were used. There were no reported complications related to the use of Botulinum Toxin. However, the short-term follow up in many cases and the lack of routine radiological assessment for recurrence suggests that the recurrence rate has been underestimated.
PPP, tissue expanders and Botulinum toxin are safe and feasible methods for abdominal wall expansion prior to incisional hernia repair. In combination with existing techniques for repair, these methods may help provide the crucial extra tissue mobility required to achieve primary closure.
系统回顾有关腹壁扩张方法的现有文献，并比较一期筋膜缝合率的结果。
使用搜索词“腹壁疝”“腹疝”“中线疝”“肉毒杆菌毒素”“保妥适”“地宝 Botox”“术前渐进性气腹”和“组织扩张器”对 Pubmed 和 Embase 数据库进行系统检索。使用非随机研究方法学指数评估研究质量。
105 项研究中，有 21 项符合纳入标准。15 项研究中的 269 例患者接受了术前渐进性气腹（PPP）治疗，其中 226 例（84%）实现了一期筋膜缝合。16 例患者复发（7.2%），并发症发生率为 12%，报告有 2 例死亡。有 4 项研究，共 14 例患者使用组织扩张器进行腹壁扩张，筋膜缝合率为 92.9%（n = 13）。报告的复发率为 10.0%（n = 1），有 1 例并发症，无死亡病例。各研究的随访时间为 3 至 36 个月。有 2 项研究报告了肉毒杆菌毒素的使用情况，共 29 例患者。尽管使用了包括成分分离和 Rives-Stoppa 修补术在内的多种技术组合，但一期筋膜缝合率为 100%（n = 29）。未报告与使用肉毒杆菌毒素相关的并发症。然而，许多病例的短期随访以及缺乏常规的复发影像学评估表明复发率可能被低估了。
PPP、组织扩张器和肉毒杆菌毒素是切口疝修补术前腹壁扩张的安全可行方法。与现有的修补技术相结合，这些方法可能有助于提供实现一期缝合所需的关键额外组织活动度。
