Struller F, Koenigsrainer I, Horvath P, Koenigsrainer A, Beckert S
Department of General, Visceral and Transplant Surgery, University Hospital Tuebingen, Tuebingen, Germany.
Scand J Surg. 2017 Dec;106(4):294-298. doi: 10.1177/1457496917690989. Epub 2017 Mar 1.
Incisional hernia formation has been reported as high as 20% within 1 year following midline laparotomy. Since hyperthermic intraperitoneal chemotherapy is likely to impair wound healing, we sought to investigate the incidence of incisional hernia formation and abdominal wall rupture following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.
Consecutive patients with radiographic evidence of peritoneal metastases were scheduled for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy at the Comprehensive Cancer Center, University Hospital Tuebingen, Germany. Clinical data were retrospectively analyzed.
Between May 2005 and May 2014, 271 patients underwent cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Within follow-up, 19 (7%) incisional hernias and 11 (4%) abdominal wall ruptures were observed. Age ⩾70 years, cardio-pulmonary comorbidity, the presence of pseudomyxoma peritonei or mesothelioma, and postoperative abdominal wall rupture were detected as risk factors for hernia formation. However, Cox multivariate analysis only confirmed the presence of pseudomyxoma peritonei or mesothelioma and postoperative abdominal wall rupture as independent risk factors.
Our data do not suggest that cytoreductive surgery and hyperthermic intraperitoneal chemotherapy is necessarily associated with a higher incidence of incisional hernia formation. However, patients suffering from pseudomyxoma peritonei or mesothelioma and patients with postoperative abdominal wall rupture seem to be at risk for developing incisional herniation.
据报道，中线剖腹手术后1年内切口疝形成率高达20%。由于腹腔内热化疗可能会损害伤口愈合，我们试图研究细胞减灭术和腹腔内热化疗后切口疝形成及腹壁破裂的发生率。
在德国图宾根大学医院综合癌症中心，对有腹膜转移影像学证据的连续患者进行细胞减灭术和腹腔内热化疗。对临床数据进行回顾性分析。
2005年5月至2014年5月期间，271例患者接受了细胞减灭术和腹腔内热化疗。在随访期间，观察到19例（7%）切口疝和11例（4%）腹壁破裂。年龄≥70岁、心肺合并症、腹膜假黏液瘤或间皮瘤的存在以及术后腹壁破裂被检测为疝形成的危险因素。然而，Cox多变量分析仅证实腹膜假黏液瘤或间皮瘤的存在以及术后腹壁破裂是独立危险因素。
我们的数据并不表明细胞减灭术和腹腔内热化疗必然与更高的切口疝形成发生率相关。然而，患有腹膜假黏液瘤或间皮瘤的患者以及术后腹壁破裂的患者似乎有发生切口疝的风险。
