Guitarte Camilla, Grant Jeremy, Zhao Huaqing, Wang Sugai, Ferriss J Stuart, Hernandez Enrique
Department of Obstetrics, Gynecology, and Reproductive Sciences, Temple University Hospital, 3401 N Broad Street, Philadelphia, PA, 19140, USA.
Department of Clinical Sciences, Temple University School of Medicine, Philadelphia, PA, USA.
Arch Gynecol Obstet. 2016 Oct;294(4):805-11. doi: 10.1007/s00404-016-4100-3. Epub 2016 Apr 21.
The aim of this study is to identify the rate of incisional hernias and associated risk factors following a vertical midline laparotomy on a gynecologic oncology service.
This is a retrospective cohort study of patients that underwent a laparotomy through a vertical midline abdominal incision between September 1998 and November 2012. Hernias and various factors were identified including demographics, disease comorbidities, intraoperative variables, and suture technique. Assessment of association with hernia formation was performed using Cox regression and log-rank test.
Two hundred and fifty-two patients with follow-up of at least 30 days were identified. Mean age was 59 years (range 21-88 years) and mean BMI was 35.9 kg/m(2) (range 17.2-84.4 kg/m(2)). Sixteen (6.3 %) developed incisional hernias with a median follow-up of 1.7 years (range 1 month to 13 years). The estimate of the 5-year probability of being hernia-free is 86 % (95 % CI 76.5-91.9). Average age of patients who developed a hernia was 66.2 years while average age of those without hernia was 58 years (p < 0.05). There was a significant association of hypertension with incisional hernia occurrence (p = 0.0035, log-rank test). Cancer was present in 100 % of patients that developed hernias and 73 % (172/236) of those that were hernia-free (p = 0.0041, log-rank test). By univariate analysis the risk of developing an incisional hernia was higher, if the abdominal fascia was closed with loop sutures (HR 4.6, 95 % CI 1.49-13.94; p = 0.008). By multivariable analysis incisions closed with loop suture had more than a fivefold increased risk of developing a hernia (HR 5.2, 95 % CI 1.65-16.39; p = 0.005). Presence of both hypertension and utilization of loop sutures had the highest risk of incisional hernia development (HR 7.1, 95 % CI 2.28-22.4; p = 0.001).
Wound complications including incisional hernias contribute to morbidity in gynecologic oncology patients. Older age, hypertension, utilization of loop sutures, and cancer were found to be associated with hernia formation after laparotomy through a vertical midline abdominal incision. The use of loop sutures to close the abdominal fascia should be investigated further.
本研究旨在确定妇科肿瘤手术中经腹正中垂直切口剖腹术后切口疝的发生率及相关危险因素。
这是一项回顾性队列研究，研究对象为1998年9月至2012年11月间经腹正中垂直切口进行剖腹手术的患者。确定了疝及各种因素，包括人口统计学特征、疾病合并症、术中变量和缝合技术。使用Cox回归和对数秩检验评估与疝形成的相关性。
确定了252例随访至少30天的患者。平均年龄为59岁（范围21 - 88岁），平均体重指数为35.9kg/m²（范围17.2 - 84.4kg/m²）。16例（6.3%）发生切口疝，中位随访时间为1.7年（范围1个月至13年）。无疝的5年概率估计为86%（95%CI 76.5 - 91.9）。发生疝的患者平均年龄为66.2岁，未发生疝的患者平均年龄为58岁（p < 0.05）。高血压与切口疝的发生有显著相关性（p = 0.0035，对数秩检验）。发生疝的患者中100%患有癌症，无疝患者中73%（172/236）患有癌症（p = 0.0041，对数秩检验）。单因素分析显示，如果用环形缝合法关闭腹横筋膜，发生切口疝的风险更高（HR 4.6，95%CI 1.49 - 13.94；p = 0.008）。多因素分析显示，用环形缝合法关闭的切口发生疝的风险增加了五倍多（HR 5.2，95%CI 1.65 - 16.39；p = 0.005）。同时存在高血压和使用环形缝合法发生切口疝的风险最高（HR 7.1，95%CI 2.28 - 22.4；p = 0.001）。
包括切口疝在内的伤口并发症会增加妇科肿瘤患者的发病率。发现年龄较大、高血压、使用环形缝合法和癌症与经腹正中垂直切口剖腹术后疝的形成有关。使用环形缝合法关闭腹横筋膜的情况应进一步研究。
