双侧腹横肌松解术：不牺牲生活质量的复杂疝修补术。
Bilateral transversus abdominis release: Complex hernia repair without sacrificing quality of life.
作者信息
Christopher Adrienne N, Fowler Cody, Patel Viren, Mellia Joseph A, Morris Martin P, Broach Robyn B, Fischer John P
机构信息
Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA; Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
出版信息
Am J Surg. 2022 Feb;223(2):250-256. doi: 10.1016/j.amjsurg.2021.03.020. Epub 2021 Mar 18.
BACKGROUND
Transversus Abdominis Release (TAR) during ventral hernia repair (VHR) allows for further lateral dissection by dividing the transversus abdominis muscles (TAM). The implications of division of the TAM on clinical and patient-reported outcomes has not be extensively studied.
METHODS
Adult patients undergoing retrorectus (RR) VHR with biosynthetic mesh with or without bilateral TAR were retrospectively identified. Post-operative and patient-reported outcomes (PROs) were collected.
RESULTS
Of 50 patients, 24 underwent TAR and 26 had RR repair alone. Median defect sizes were 449 cm and 208 cm, respectively (p < 0.001). Rates of SSO and SSI were similar (p > 0.05). One TAR patient (4.2%) and four RR patients (15.4%) recurred (p = 0.26), with median follow up of 24 and 38 months. PROs improved significantly in both groups (p < 0.05).
CONCLUSION
Despite more complex abdominal wall reconstruction on larger defects, TAR has minimal major adverse events, low recurrence rates, and does not negatively affect PROs.
背景
腹横肌松解术（TAR）用于腹侧疝修补术（VHR）时，可通过分离腹横肌（TAM）进行更广泛的外侧解剖。TAM分离对临床和患者报告结局的影响尚未得到广泛研究。
方法
回顾性纳入接受腹直肌后（RR）VHR并使用生物合成补片且行或未行双侧TAR的成年患者。收集术后和患者报告结局（PROs）。
结果
50例患者中，24例行TAR，26例仅行RR修补术。中位缺损大小分别为449 cm和208 cm（p < 0.001）。手术部位感染（SSO）和手术切口感染（SSI）发生率相似（p > 0.05）。1例TAR患者（4.2%）和4例RR患者（15.4%）复发（p = 0.26），中位随访时间分别为24个月和38个月。两组患者报告结局均显著改善（p < 0.05）。
结论
尽管对较大缺损进行腹壁重建更为复杂，但TAR的主要不良事件极少，复发率低，且对患者报告结局无负面影响。
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