Bilezikian Jordan A, Faulkner Justin D, Fox Sarah S, Hooks W Borden, Hope William W
Department of Surgery, New Hanover Regional Medical Center, Wilmington, NC.
Surg Technol Int. 2019 Nov 10;35:129-134.
Abdominal wall tension is an integral concept in hernia repair. Most of the described techniques attempt to reduce abdominal wall tension by using mesh prosthetics or myofascial release. Although the concept of a "tension-free" hernia repair is well-understood and appreciated by surgeons, quantitative information about abdominal wall tension is limited. This review evaluates the published literature related to abdominal wall tension and summarizes how the measurement of intraoperative tension can guide clinical decision-making. Most of the methods and techniques for measuring abdominal wall tension are similar and involve the use of tensiometers. However, there is no accepted standardized technique. Baseline tension measurements confirm the concept of a baseline physiological tension, and it has been observed that tension does not correlate with hernia width. When the tension is considered to be too great during hernia repair, intraoperative techniques such as myofascial release can be used to reduce tension to physiological values. Emerging data from clinical studies on tension have added to our understanding of the mechanics and physiology of the abdominal wall. Standardized devices and measurement techniques need to be developed and validated to foster the utility of tension measurements in hernia repair.
腹壁张力是疝修补术中的一个重要概念。大多数所描述的技术试图通过使用网状假体或肌筋膜松解来降低腹壁张力。尽管“无张力”疝修补的概念已被外科医生充分理解和认可，但有关腹壁张力的定量信息却很有限。这篇综述评估了与腹壁张力相关的已发表文献，并总结了术中张力测量如何指导临床决策。大多数测量腹壁张力的方法和技术相似，都涉及使用张力计。然而，目前尚无公认的标准化技术。基线张力测量证实了基线生理张力的概念，并且已经观察到张力与疝的宽度无关。当在疝修补术中认为张力过大时，可采用肌筋膜松解等术中技术将张力降低至生理值。关于张力的临床研究的新数据增进了我们对腹壁力学和生理学的理解。需要开发和验证标准化设备及测量技术，以促进张力测量在疝修补术中的应用。
