Shearer Tara R, Holcombe Susan J, Valberg Stephanie J
Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI.
J Vet Emerg Crit Care (San Antonio). 2020 Mar;30(2):136-148. doi: 10.1111/vec.12936. Epub 2020 Feb 25.
To review the veterinary literature regarding healing and complications associated with equine celiotomy including anatomy and physiology, risk factors for incisional infection and hernia, and treatment.
Celiotomy is the most common approach to treat horses with surgical colic. Incision through the linea alba provides exposure to most of the abdomen for exploration, exteriorization, and correction of surgical lesions. Incisional apposition relies on suture strength during anesthetic recovery and for the first 30 days postoperatively. Factors associated with the patient, surgical lesion and procedures, anesthesia, and recovery put the horse at risk for surgical site infection. Infection is the most important risk factor for incisional hernia formation.
A presumptive diagnosis of surgical site infection is made based on the presence of fever and incisional swelling, pain, and discharge. Ultrasonography can be used to identify areas of fluid accumulation prior to the appearance of incisional drainage. Definitive diagnosis is based on positive bacteriologic culture of the incisional discharge. Incisional hernia is diagnosed by palpation of the incision, usually 30-60 days after surgery. Ultrasound of the incision may aide in early diagnosis of incisional hernia if gaps along the incision in the linea alba are apparent.
No objective data exist to assess the efficacy of specific therapies for surgical site infections following celiotomy. Principles of treatment include the establishment of drainage, bandaging, antimicrobial therapy based on culture and sensitivity, and extended rest in an attempt to avoid incisional hernia or dehiscence. Treatment for incisional hernia includes prolonged circumferential bandaging, open or minimally invasive hernia repair, or no treatment.
Incisional complications are associated with prolonged convalescence and diminished prognosis for return to athleticism. Limiting risk factors for surgical site infections, prompt treatment, and incisional support may optimize celiotomy healing and timely return to function. Horses compete in many disciplines with incisional hernias.
回顾有关马腹部切开术愈合及并发症的兽医文献，内容包括解剖学和生理学、切口感染和疝气的危险因素以及治疗方法。
腹部切开术是治疗患手术性腹痛马匹最常用的方法。通过白线切开可暴露大部分腹腔，以便进行探查、将病变肠段引出体外以及纠正手术病变。切口对合在麻醉苏醒期间及术后头30天依赖缝线的强度。与病马、手术病变及操作、麻醉和恢复相关的因素使马有发生手术部位感染的风险。感染是切口疝形成的最重要危险因素。
根据发热、切口肿胀、疼痛和渗液做出手术部位感染的初步诊断。超声检查可在切口出现引流之前确定积液区域。确诊基于切口渗液细菌培养阳性。切口疝通常在术后30 - 60天通过触诊切口进行诊断。如果白线处切口有明显间隙，切口超声检查可能有助于切口疝的早期诊断。
目前尚无客观数据评估腹部切开术后手术部位感染的特定治疗方法的疗效。治疗原则包括建立引流、包扎、根据培养和药敏结果进行抗菌治疗以及延长休息时间，以避免切口疝或切口裂开。切口疝的治疗方法包括长期环形包扎、开放或微创疝修补术，或不进行治疗。
切口并发症与康复期延长及恢复运动能力的预后不良相关。限制手术部位感染的危险因素、及时治疗和切口支撑可能会优化腹部切开术的愈合并及时恢复功能。有切口疝的马匹仍可参加许多项目的比赛。
