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改良 Chevrel 技术:外科医生的救星。

Modified Chevrel Technique: A Lifesaver for Surgeons.

机构信息

Department of Surgery, Faculty of Medicine, Muğla Sitki Koçman University, Mugla 48000, Turkey.

出版信息

Medicina (Kaunas). 2024 Aug 16;60(8):1328. doi: 10.3390/medicina60081328.

Abstract

Ventral hernias (VH) pose significant challenges for surgeons due to the risk of recurrence, complexities in aligning abdominal muscles, and selecting the most suitable layer for mesh augmentation. This study aims to evaluate the effectiveness of utilizing the anterior rectus fascia as a turnover flap in conjunction with onlay mesh reinforcement, a procedure known as the modified Chevrel technique (MCT). : We conducted a retrospective analysis of patients who were operated on using MCT for abdominal hernias between January 2013 and December 2019. Data were extracted from our hospital's electronic database. Recurrence rates, as well as the rates of surgical site occurrences (SSO), surgical site infections (SSI), and surgical site occurrences requiring procedural intervention (SSOPI), were analyzed based on patients' comorbidities and demographic characteristics. : The median follow-up period was 42.9 months (range: 14-96), and the recurrence rate was 4% (n = 3). Among the recurrent cases, three patients had chronic obstructive pulmonary disease, representing a statistically significant association ( = 0.02). Although all patients with recurrence were obese, this association did not reach statistical significance ( > 0.05). The mean hospitalization duration was 17.6 days (range: 6-29). SSO, SSI, and SSOPI rates were 39 (52%), 12 (16%), and 32 (42%), respectively. : Managing VH remains a surgical challenge, emphasizing the importance of achieving effective abdominal closure for both functional and cosmetic outcomes. MCT presents a relatively simple approach compared to techniques like transversus abdominis release (TAR) and anterior component separation (ACS), with acceptable rates of SSO, SSOPI, SSI, and recurrence.

摘要

腹壁疝(VH)给外科医生带来了重大挑战,因为存在复发风险、腹部肌肉对齐的复杂性以及选择最适合网片增强的层的问题。本研究旨在评估使用前腹直肌筋膜作为翻转瓣与覆盖网片增强联合使用的效果,该方法称为改良 Chevrel 技术(MCT)。

我们对 2013 年 1 月至 2019 年 12 月期间使用 MCT 治疗腹壁疝的患者进行了回顾性分析。数据从我们医院的电子数据库中提取。根据患者的合并症和人口统计学特征,分析复发率以及手术部位事件(SSO)、手术部位感染(SSI)和需要手术干预的手术部位事件(SSOPI)的发生率。

中位随访时间为 42.9 个月(范围:14-96),复发率为 4%(n=3)。在复发病例中,有 3 例患有慢性阻塞性肺疾病,具有统计学显著关联(=0.02)。尽管所有复发患者均肥胖,但这种关联没有达到统计学意义(>0.05)。平均住院时间为 17.6 天(范围:6-29)。SSO、SSI 和 SSOPI 的发生率分别为 39(52%)、12(16%)和 32(42%)。

管理 VH 仍然是一项外科挑战,强调实现有效的腹部闭合对于功能和美容结果都很重要。与横腹肌释放(TAR)和前侧组件分离(ACS)等技术相比,MCT 是一种相对简单的方法,其 SSO、SSOPI、SSI 和复发率可接受。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8f23/11356506/34a0fee8a864/medicina-60-01328-g001.jpg

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