注意：切勿使用图钉将网片固定到膈肌上！
A word of caution: never use tacks for mesh fixation to the diaphragm!
机构信息
Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstrasse 6, 13585, Berlin, Germany.
Hernia Center, Winghofer Medicum, Winghofer Strasse 42, 72108, Rottenburg am Neckar, Germany.
出版信息
Surg Endosc. 2018 Jul;32(7):3295-3302. doi: 10.1007/s00464-018-6050-2. Epub 2018 Jan 16.
BACKGROUND
The mesh fixation technique used in repair of hiatal hernias and subxiphoid ventral and incisional hernias must meet strenuous requirements. In the literature, there are reports of life-threatening complications with cardiac tamponade and a high mortality rate on using tacks. The continuing practice of tack deployment for mesh fixation to the diaphragm and esophageal hiatus should be critically reviewed.
METHODS
In a systematic search of the available literature in May 2017, 23 cases of severe penetrating cardiac complications were identified. The authors became aware of two other cases in which they acted as medical experts. Furthermore, the instructions for use issued by the manufacturers of the tacks were reviewed with regard to their deployment in the diaphragm.
RESULTS
Twenty-three of 25 cases (92%) with severe cardiac injuries and subsequent cardiac tamponade were triggered by the use of tacks in the diaphragm. In six cases (24%), these related to ventral and incisional hernias with extension to the subxiphoid area, and in 19 cases (76%) to mesh-augmented hiatoplasty. Twelve of 25 (48%) patients died as a result of pericardial and/or heart muscle injury with cardiac tamponade despite heart surgery intervention. In the tack manufacturers' instructions for use, their deployment in the diaphragm, in particular in the vicinity of the heart, is contraindicated. Likewise, the existing guidelines urgently advise against the use of tacks in the diaphragm, recommending instead alternative fixation techniques.
CONCLUSIONS
Tacks should not be used for mesh fixation in the diaphragm above the costal arch.
背景
用于修复食管裂孔疝和剑突下腹膜前及切口疝的网片固定技术必须满足严格的要求。在文献中，有报道称使用缝合钉会导致心脏压塞的危及生命的并发症和高死亡率。因此，继续使用缝合钉将网片固定到膈肌和食管裂孔的做法应受到严格审查。
方法
在 2017 年 5 月对现有文献进行系统检索后，确定了 23 例严重穿透性心脏并发症的病例。作者还了解到另外两例作为医学专家参与的病例。此外，还审查了缝合钉制造商关于在膈肌中使用缝合钉的使用说明。
结果
25 例严重心脏损伤和随后发生心脏压塞的病例中，有 23 例（92%）是由缝合钉在膈肌中的使用引起的。其中 6 例（24%）与延伸至剑突下区域的前腹壁和切口疝有关，19 例（76%）与网片增强的食管裂孔修补术有关。在 25 例患者中，有 12 例（48%）尽管进行了心脏手术干预，但由于心包和/或心肌损伤导致心脏压塞而死亡。在缝合钉制造商的使用说明中，缝合钉在膈肌中的使用，特别是在心脏附近，是被禁止的。同样，现有的指南强烈建议不要在膈肌中使用缝合钉，而推荐使用其他固定技术。
结论
缝合钉不应用于肋弓以上的膈肌中的网片固定。
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