Giordano Salvatore, Garvey Patrick B, Baumann Donald P, Liu Jun, Butler Charles E
Houston, Texas.
From the Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center.
Plast Reconstr Surg. 2017 Dec;140(6):1263-1273. doi: 10.1097/PRS.0000000000003855.
Studies of abdominal wall reconstruction with concurrent panniculectomy have reported contradictory results. The authors hypothesized that patients undergoing abdominal wall reconstruction with concurrent panniculectomy experience more wound healing complications but similar rates of hernia recurrence compared with abdominal wall reconstruction alone.
Of 548 consecutive patients, 305 patients (55.7 percent) underwent abdominal wall reconstruction alone and 243 (44.3 percent) underwent abdominal wall reconstruction with concurrent panniculectomy. Mean follow-up was 30 months. The authors compared these two groups' postoperative complications and outcomes before and after propensity score analysis.
Abdominal wall reconstruction with concurrent panniculectomy patients had a significantly higher overall complication rate (38.3 percent versus 29.2 percent; p = 0.025) and a trend toward a higher surgical-site occurrence rate (27.6 percent versus 20.7 percent; p = 0.06) compared with abdominal wall reconstruction alone. There were significantly higher incidences of skin dehiscence (19.3 percent versus 12.5 percent; p = 0.032), fat necrosis (10.7 percent versus 3.6 percent; p = 0.002), and infection abscess (9.5 percent versus 4.3 percent; p = 0.023) but no significant difference in hernia recurrence (6.9 percent versus 11.5 percent; p = 0.27) at long-term follow-up. Propensity score analysis yielded 188 pairs of matched patients with no significant differences in overall complication and hernia recurrence rates. Significantly higher rates of fat necrosis (9.6 percent versus 4.3 percent; p = 0.041) and abscess (10.1 percent versus 3.2 percent; p = 0.007) were observed in the abdominal wall reconstruction with concurrent panniculectomy group.
Abdominal wall reconstruction with concurrent panniculectomy is associated with higher wound morbidity but similar surgical-site occurrence and hernia recurrence rates at long-term follow-up. The authors believe that panniculectomy can be safely performed when indicated.
关于同期行腹壁重建术与腹壁整形术的研究报告结果相互矛盾。作者推测，与单纯腹壁重建术相比，同期行腹壁重建术与腹壁整形术的患者伤口愈合并发症更多，但疝复发率相似。
在548例连续患者中，305例患者（55.7%）仅接受了腹壁重建术，243例患者（44.3%）接受了同期腹壁重建术与腹壁整形术。平均随访时间为30个月。作者在倾向评分分析前后比较了这两组患者的术后并发症和结局。
与单纯腹壁重建术相比，同期行腹壁重建术与腹壁整形术的患者总体并发症发生率显著更高（38.3%对29.2%；p = 0.025），手术部位发生率有升高趋势（27.6%对20.7%；p = 0.06）。皮肤裂开（19.3%对12.5%；p = 0.032）、脂肪坏死（10.7%对3.6%；p = 0.002）和感染性脓肿（9.5%对4.3%；p = 0.023）的发生率显著更高，但长期随访时疝复发率无显著差异（6.9%对11.5%；p = 0.27）。倾向评分分析产生了188对匹配患者，总体并发症和疝复发率无显著差异。同期行腹壁重建术与腹壁整形术组的脂肪坏死率（9.6%对4.3%；p = 0.041）和脓肿率（10.1%对3.2%；p = 0.007）显著更高。
同期行腹壁重建术与腹壁整形术与更高的伤口发病率相关，但长期随访时手术部位发生率和疝复发率相似。作者认为，在有指征时可安全地进行腹壁整形术。
