Read John W, Ibrahim Nabeel, Jacombs Anita S W, Elstner Kristen E, Saunders Jeni, Rodriguez-Acevedo Omar
Department of Clinical Medicine, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia.
Macquarie Medical Imaging, Macquarie University Hospital, Sydney, NSW, Australia.
Front Surg. 2022 Feb 25;9:799277. doi: 10.3389/fsurg.2022.799277. eCollection 2022.
The successful repair of any complex ventral hernia requires a thorough understanding of the underlying anatomical defect and its functional context. We describe an improved "functional" approach to CT imaging of the abdominal wall that can facilitate this understanding and assist surgical planning.
This invited article reports the observational experience gained from the functional abdominal wall CT examinations of 88 patients who underwent complex ventral hernia repair using pre-operative Botulinum toxin A (BTA) infiltration of the lateral oblique abdominal muscles as well as a further eight patients with diastasis rectus abdominis who were examined to exclude ventral hernia.
The use of a functional CT protocol which supplements resting images with additional "crunching" images (acquired with the abdominal wall muscles all strongly contracted) can significantly improve the demonstration of ventral hernia defects. Crunching acquisitions can also help differentiate true hernias from dysfunctional bulges, identify muscle denervation or atrophic changes, reveal otherwise occult hernias that may be missed on resting or Valsalva images alone, and assist the pre-operative assessment of BTA effect.
A more functional approach to pre-operative CT imaging of the abdominal wall can significantly improve the understanding of complex ventral hernia defects and help formulate effective surgical plans that achieve low recurrence rates and good functional outcomes.
成功修复任何复杂的腹侧疝需要全面了解潜在的解剖缺陷及其功能背景。我们描述了一种改进的腹壁CT成像“功能”方法，该方法有助于这种理解并辅助手术规划。
这篇特邀文章报告了对88例行复杂腹侧疝修补术患者进行腹壁功能性CT检查的观察经验，这些患者术前使用A型肉毒杆菌毒素（BTA）浸润腹外斜肌，另外还对8例腹直肌分离患者进行了检查以排除腹侧疝。
使用功能性CT方案，用额外的“收缩”图像（在腹壁肌肉强烈收缩时获取）补充静息图像，可显著改善腹侧疝缺损的显示。收缩图像采集还可帮助区分真正的疝与功能失调性膨出，识别肌肉失神经支配或萎缩性改变，发现仅靠静息或瓦尔萨尔瓦动作图像可能遗漏的隐匿性疝，并协助术前评估BTA效果。
对腹壁进行更具功能性的术前CT成像方法可显著提高对复杂腹侧疝缺损的理解，并有助于制定有效手术方案，以实现低复发率和良好的功能结果。
