Garvey Patrick B, Giordano Salvatore A, Baumann Donald P, Liu Jun, Butler Charles E
Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX.
Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX.
J Am Coll Surg. 2017 Mar;224(3):341-350. doi: 10.1016/j.jamcollsurg.2016.11.017. Epub 2016 Dec 18.
Long-term outcomes data for hernia recurrence rates after abdominal wall reconstruction (AWR) with acellular dermal matrix (ADM) are lacking. The aim of this study was to assess the long-term durability of AWR using ADM.
We studied patients who underwent AWR with ADM at a single center in 2005 to 2015 with a minimum follow-up of 36 months. Hernia recurrence was the primary end point and surgical site occurrence (SSO) was a secondary end point. The recurrence-free survival curves were estimated by Kaplan-Meier product limit method. Univariate and multivariable Cox proportional hazards regression models and logistic regression models were used to evaluate the associations of risk factors at surgery with subsequent risks for hernia recurrence and SSO, respectively.
A total of 512 patients underwent AWR with ADM. After excluding those with follow-up less than 36 months, 191 patients were included, with a median follow-up of 52.9 months (range 36 to 104 months). Twenty-six of 191 patients had a hernia recurrence documented in the study. The cumulative recurrence rates were 11.5% at 3 years and 14.6% by 5 years. Factors significantly predictive of hernia recurrence developing included bridged repair, wound skin dehiscence, use of human cadaveric ADM, and coronary disease; component separation was protective. In a subset analysis excluding bridged repairs and human cadaveric ADM patients, cumulative hernia recurrence rates were 6.4% by 3 years and 8.3% by 5 years. The crude rate of SSO was 25.1% (48 of 191). Factors significantly predictive of the incidence of SSO included at least 1 comorbidity, BMI ≥30 kg/m, and defect width >15 cm.
Use of ADM for AWR was associated with 11.5% and 14.6% hernia recurrence rates at 3- and 5-years follow-up, respectively. Avoiding bridged repairs and human cadaveric ADM can improve long-term AWR outcomes using ADM.
缺乏关于使用脱细胞真皮基质（ADM）进行腹壁重建（AWR）后疝复发率的长期结果数据。本研究的目的是评估使用ADM进行AWR的长期耐久性。
我们研究了2005年至2015年在单一中心接受ADM AWR的患者，最小随访时间为36个月。疝复发是主要终点，手术部位事件（SSO）是次要终点。采用Kaplan-Meier乘积限界法估计无复发生存曲线。单变量和多变量Cox比例风险回归模型以及逻辑回归模型分别用于评估手术时的危险因素与随后疝复发和SSO风险之间的关联。
共有512例患者接受了ADM AWR。排除随访时间少于36个月的患者后，纳入191例患者，中位随访时间为52.9个月（范围36至104个月）。191例患者中有26例在研究中有疝复发记录。3年时的累积复发率为11.5%，5年时为14.6%。显著预测疝复发的因素包括桥接修复、伤口皮肤裂开、使用人尸体ADM和冠心病；成分分离具有保护作用。在排除桥接修复和人尸体ADM患者的亚组分析中，3年时的累积疝复发率为6.4%，5年时为8.3%。SSO的粗发生率为25.1%（191例中的48例）。显著预测SSO发生率的因素包括至少1种合并症、BMI≥30 kg/m²和缺损宽度>15 cm。
在3年和5年随访中，使用ADM进行AWR的疝复发率分别为11.5%和14.6%。避免桥接修复和人尸体ADM可以改善使用ADM进行AWR的长期结果。
