Mommers Elwin H H, Wegdam Johannes A, van der Wolk Sander, Nienhuijs Simon W, de Vries Reilingh Tammo S
Department of Surgery, Elkerliek Hospital, Helmond, The Netherlands; Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
Department of Surgery, Elkerliek Hospital, Helmond, The Netherlands.
J Surg Res. 2017 May 1;211:8-13. doi: 10.1016/j.jss.2016.11.051. Epub 2016 Dec 7.
Despite a multitude of evidence-based prediction models and risk factors for postoperative complications after ventral hernia repair, estimating a patient's risk of postoperative complications after ventral hernia repair remains challenging. In an attempt to improve the preoperative assessment of complex hernia patients, some studies have examined pulmonary changes after hernia repair hypothesizing that large hernias lead to pulmonary changes and increased pulmonary complication rates. Some studies have described a correlation between hernia volume and pulmonary changes, although none provided compelling evidence to identify hernia volume as a risk factor for pulmonary complications. This study evaluates the relationship between hernia volume and postoperative pulmonary complications using computed tomography (CT)-based volume measurements.
Analysis of a prospectively maintained database of consecutive complex hernia patients from 2011 to 2014 undergoing endoscopic (ECST) or open component separation technique (CST) for a hernia defect with a minimum width of 6 cm and visual protrusion of the hernia sac ventral of the rectus abdominis muscles in supine position was performed. Hernia volume was calculated using multiple plane reconstruction of a standard abdominal CT-scan. Noted endpoints were pulmonary complications.
Thirty-five patients underwent ECST (n = 20) or CST (n = 15) with a median defect volume of 474 cm (range, 114-2086 cm). Observed complications were pneumonia (n = 4), pulmonary infiltrate (n = 3), aspiration pneumonia (n = 2), and acute respiratory distress syndrome (n = 1). Univariate and multivariate analyses showed that pulmonary complications were associated with "hernia volume" (P = 0.045; 95% CI: 1.008-1.910).
Hernia volume is a promising risk factor for postoperative pulmonary complications and can be calculated using a standard abdominal CT-scan.
尽管有大量基于证据的预测模型和腹疝修补术后并发症的危险因素，但估计患者腹疝修补术后并发症的风险仍然具有挑战性。为了改善对复杂疝患者的术前评估，一些研究检查了疝修补术后的肺部变化，假设大疝会导致肺部变化并增加肺部并发症发生率。一些研究描述了疝体积与肺部变化之间的相关性，尽管没有一项研究提供令人信服的证据来确定疝体积是肺部并发症的危险因素。本研究使用基于计算机断层扫描（CT）的体积测量来评估疝体积与术后肺部并发症之间的关系。
对2011年至2014年连续的复杂疝患者的前瞻性维护数据库进行分析，这些患者接受了内镜（ECST）或开放成分分离技术（CST）治疗，疝缺损最小宽度为6 cm，仰卧位时疝囊在腹直肌腹侧有明显突出。使用标准腹部CT扫描的多平面重建计算疝体积。记录的终点是肺部并发症。
35例患者接受了ECST（n = 20）或CST（n = 15），中位缺损体积为474 cm（范围，114 - 2086 cm）。观察到的并发症包括肺炎（n = 4）、肺部浸润（n = 3）、吸入性肺炎（n = 2）和急性呼吸窘迫综合征（n = 1）。单因素和多因素分析表明，肺部并发症与“疝体积”相关（P = 0.045；95% CI：1.008 - 1.910）。
疝体积是术后肺部并发症的一个有前景的危险因素，可使用标准腹部CT扫描进行计算。
