Louis D, Stoppa R, Henry X, Verhaeghe P
J Chir (Paris). 1985 Oct;122(10):523-7.
The 247 eventrations operated upon concerned 230 patients (60% women and 40% men) mean age 54.5 years. Eventrations were large (collar greater than 10 cm) in 18, 5% and were in the median line in 81%. Serial laparotomies by the same approach had been performed in 21%, the principal causes of eventration being biliary and gynecologic surgery. Parietal sepsis developed in 31,5% of cases after operation for the original affection. Classical favoring factors found included obesity (51%), multiparity (42% of women) and chronic lung disease (14%). Preoperative preparation involved the use of Goni Moreno's progressive pneumoperitoneum in 18,5% of patients. Procedures used were parietal repair by raphe (22%), the same but with the addition of a dacron prosthesis (6%) or the large dacron tulle prosthesis for wide reinforcement of the visceral sac (67% of cases). Early sepsis was a slightly more frequent occurrence after dacron tulle, predisposing factors being the prosthesis itself, a previous history of parietal sepsis, swabs and the number of Redon tubes. After use of dacron tulle complications were mainly also hematoma (3.2%) and skin necrosis (2,6%). Postoperative course in general was uncomplicated in 91% of the 247 operations. Follow up of 67% of operated patients for a mean of 5 1/2 years showed recurrence in 50% of raphe procedures and 18.5% of prosthesis implantations; factors of aseptic recurrence (16,5%) were multiparity and chronic lung disease. Delayed sepsis after dacron tulle use affected 8% of patients and were related to chronicity of early sepsis, nonresorbable sutures and sepsis complicating the primary laparotomy. Doming of the parietal wall was noted in 4% of cases repaired by prosthesis.(ABSTRACT TRUNCATED AT 250 WORDS)
接受手术治疗的247例腹壁疝涉及230名患者(女性占60%,男性占40%),平均年龄54.5岁。其中18例(5%)为巨大腹壁疝(疝环大于10厘米),81%位于中线。21%的患者曾采用相同入路进行过多次剖腹手术,腹壁疝的主要病因是胆道和妇科手术。31.5%的患者在针对原发病进行手术后发生了腹壁感染。发现的典型促发因素包括肥胖(51%)、多产(女性患者中的42%)和慢性肺病(14%)。18.5%的患者术前采用了戈尼·莫雷诺渐进性气腹术。采用的手术方法包括用缝线进行腹壁修补(22%),同样方法但加用涤纶补片(6%)或用大涤纶网片假体广泛加固内脏囊(67%的病例)。使用涤纶网片后早期感染的发生率略高,诱发因素包括补片本身、既往腹壁感染史、拭子检查及雷东引流管数量。使用涤纶网片后的并发症主要还有血肿(3.2%)和皮肤坏死(2.6%)。在这247例手术中,91%的患者术后病程总体无并发症。对67%的手术患者平均随访5.5年发现,缝线修补术的复发率为50%,假体植入术的复发率为18.5%;无菌性复发因素(16.5%)为多产和慢性肺病。使用涤纶网片后的迟发性感染影响了8%的患者,与早期感染的慢性化、不可吸收缝线以及初次剖腹手术并发的感染有关。采用假体修补的病例中有4%出现了腹壁壁层隆起。(摘要截选于250词)