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束腰躯干整形术:适用于腹部皮肤松弛和开腹胆囊切除术疤痕的情况。

Corset Trunkplasty: Recommended with Abdominal Skin Laxity and Open Cholecystectomy Scar.

作者信息

Acevedo Edwin, Nadhan Kumar S, Everett Marc, Moya Alexander, Bradley James P

机构信息

Philadelphia and Danville, Pa.

From the Division of Plastic and Reconstructive Surgery, Temple University; and the Division of Plastic and Reconstructive Surgery, Geisinger Medical Center.

出版信息

Plast Reconstr Surg. 2018 Jan;141(1):60-69. doi: 10.1097/PRS.0000000000003988.

Abstract

BACKGROUND

Patients undergoing abdominoplasty with previous upper abdominal wall scars are at an increased risk for postoperative complications. The corset trunkplasty is a newer technique to treat abdominal wall laxity of the entire anterolateral abdomen while incorporating any previous open cholecystectomy scar. The authors performed a comparative outcomes study to determine whether the corset procedure would decrease the incidence of postoperative complications in patients with abdominal wall laxity and an open cholecystectomy scar when compared with traditional abdominoplasty.

METHODS

A retrospective study was performed on patients who underwent traditional and corset abdominoplasty. Patients were divided into four groups: traditional with scar, corset with scar, traditional no scar, and corset no scar. Evaluated metrics included procedure time, postoperative length of stay, complications, reoperations, and readmission rates.

RESULTS

Fifty-eight subjects were included in the study (traditional with scar, n = 15; corset with scar, n = 13; traditional no scar, n = 15; and corset no scar, n = 15). Demographics were similar among groups: body mass index, 33.7 kg/m; age, 44.3 years; and American Society of Anesthesiologists status, 2.5. The corset procedure took longer than the traditional method, regardless of whether a scar was present (146.1 minutes versus 125.7 minutes). However, the traditional with scar group had the greatest length of stay and higher complication, readmission, and reoperation rates. The corset with scar group had comparable outcomes to the corset no scar and traditional no scar groups.

CONCLUSIONS

The corset trunkplasty procedure resulted in fewer adverse outcomes compared with traditional abdominoplasty in patients with previous open cholecystectomy scar. Its use should be considered in patients with significant abdominal wall laxity and existing upper abdominal surgical scars.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

摘要

背景

既往有上腹部壁瘢痕的患者接受腹壁成形术时,术后并发症风险增加。束腰躯干成形术是一种治疗整个前外侧腹壁松弛的新技术,同时可纳入既往任何开腹胆囊切除术瘢痕。作者进行了一项比较性结局研究,以确定与传统腹壁成形术相比,束腰手术是否会降低腹壁松弛且有开腹胆囊切除术瘢痕患者的术后并发症发生率。

方法

对接受传统和束腰腹壁成形术的患者进行回顾性研究。患者分为四组:有瘢痕的传统组、有瘢痕的束腰组、无瘢痕的传统组和无瘢痕的束腰组。评估指标包括手术时间、术后住院时间、并发症、再次手术和再入院率。

结果

58名受试者纳入研究(有瘢痕的传统组,n = 15;有瘢痕的束腰组,n = 13;无瘢痕的传统组,n = 15;无瘢痕的束腰组,n = 15)。各组间人口统计学特征相似:体重指数为33.7kg/m;年龄为44.3岁;美国麻醉医师协会分级为2.5级。无论有无瘢痕,束腰手术所需时间均比传统方法长(146.1分钟对125.7分钟)。然而,有瘢痕的传统组住院时间最长,并发症、再入院和再次手术率更高。有瘢痕的束腰组与无瘢痕的束腰组和无瘢痕的传统组结局相当。

结论

对于既往有开腹胆囊切除术瘢痕的患者,与传统腹壁成形术相比,束腰躯干成形术导致的不良结局更少。对于有明显腹壁松弛和现有上腹部手术瘢痕的患者,应考虑使用该方法。

临床问题/证据级别:治疗性,III级

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