Petersson U, Bjarnason T, Björck M, Montgomery A, Rogmark P, Svensson M, Sörelius K, Acosta S
Department of Clinical Sciences Malmö, Lund University, Lund, Sweden.
Department of Surgery, Skane University Hospital, Malmö, Sweden.
Hernia. 2016 Oct;20(5):755-64. doi: 10.1007/s10029-016-1516-4. Epub 2016 Jun 21.
To report incisional hernia (IH) incidence, abdominal wall (AW) discomfort and quality of life (QoL) 5 years after open abdomen treatment with vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM).
Five-year follow-up of patients included in a prospective study 2006-2009. The protocol included physical examination, patient interview, chart review, questionnaires on abdominal wall and stoma complaints and the SF-36 questionnaire.
Fifty-five (12 women, 43 men; median age 70 years) of 111 included patients were alive. Follow-up rate was 91 %. Cumulative IH incidence during the whole study was 62 %. One-third of the IHs was repaired. At 5-year follow-up 59 % of IHs were clinically detectable. AW symptoms were equivalent in patients with (15/23) and without (11/21) IH (p = 0.541). SF-36 scores were lower than population mean for component scores and all subscales except bodily pain. Patients with major co-morbidity had lower physical component score [31.6 (95 %, CI 25.6-37.4)] compared to those without [48.9 (95 %, CI 46.2-51.4)]. Major co-morbidity was not associated with IH (p = 0.56), AW symptoms (p = 0.54) or stoma (p = 0.10). Patients with IH or other AW symptoms had similar SF-36 results compared to those without, whereas patients with a stoma had >5 point lower mean scores for general health, social function and physical component score compared to those without.
VAWCM treatment results in high incidence of IH. However, at five years, there was no detectable difference in abdominal wall complaints and QoL in patients with IH compared to those without. Lower QoL appeared mainly to be associated with the presence of major co-morbidity.
报告采用负压伤口封闭联合补片介导的筋膜牵引（VAWCM）治疗开放性腹部损伤5年后的切口疝（IH）发生率、腹壁（AW）不适及生活质量（QoL）。
对2006年至2009年一项前瞻性研究纳入的患者进行5年随访。方案包括体格检查、患者访谈、病历审查、关于腹壁和造口问题的问卷以及SF - 36问卷。
111例纳入患者中有55例（12例女性，43例男性；中位年龄70岁）存活。随访率为91%。整个研究期间IH的累积发生率为62%。三分之一的IH进行了修复。在5年随访时，59%的IH在临床上可检测到。有IH（15/23）和无IH（11/21）的患者AW症状相当（p = 0.541）。除躯体疼痛外，SF - 36各成分得分及所有子量表得分均低于总体均值。有严重合并症的患者身体成分得分[31.6（95%，CI：25.6 - 37.4）]低于无严重合并症的患者[48.9（95%，CI：46.2 - 51.4）]。严重合并症与IH（p = 0.56）、AW症状（p = 0.54）或造口（p = 0.10）无关。有IH或其他AW症状的患者与无这些情况的患者相比，SF - 36结果相似，而有造口的患者与无造口的患者相比，总体健康、社会功能和身体成分得分平均低5分以上。
VAWCM治疗导致IH发生率较高。然而，在5年时，有IH的患者与无IH的患者相比，腹壁不适和生活质量方面无明显差异。生活质量较低主要似乎与严重合并症的存在有关。
