对接受A型肉毒杆菌毒素术前治疗的中线切口疝或外侧疝患者腹部CT扫描观察到的形态学变化的研究。

Study of morphological changes observed on abdominal CT scan after preoperative treatment with botulinum toxin type A in patients with midline incisional hernias or lateral component.

作者信息

Argudo Garijo Salvador, Jiménez Jiménez Félix Javier, Ramírez Calderón Jessie, Jullien Petrelli Ariel Christian, Del Corral Rodríguez Javier, Hernández García Miguel, García-Conde Delgado María, Alonso Poza Alfredo

机构信息

Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario del Sureste, Madrid, Spain.

Servicio de Neurología, Hospital Universitario del Sureste, Madrid, Spain.

出版信息

Cir Esp (Engl Ed). 2025 Jul;103(7):800117. doi: 10.1016/j.cireng.2025.800117. Epub 2025 May 16.

DOI:10.1016/j.cireng.2025.800117

PMID:40383447

Abstract

INTRODUCTION

Preoperative treatment with botulinum toxin (BT) is very common in complex incisional hernias, although it lacks clear indications.

METHODS

Between July 2019 and May 2022, measurements of the thickness and length of the lateral abdominal wall, transverse diameter of the abdomen and diameter of the hernia defect were taken from patient CT scans both pre- and post-treatment with BT at our hospital. In order to establish differences between patients with lateral and midline hernias, a logistic regression analysis was performed.

RESULTS

The study included 23 patients: 17 had midline hernias, and 6 had lateral hernias (4 right and 2 bilateral). We observed increased length of the right wall (1.15 ± 1.64 cm; P = .0029), left wall (1.96 ± 1.74 cm; P < .0001) and transverse abdominal diameter (2.85 ± 4.83 cm; P < .0001), and a reduction in the thickness of the right (-0.54 ± 0.53 cm; P < .0001) and left walls (-0.58 ± 0.42 cm; P < .0001). There were no differences in the transverse diameter of the defect (-0.01 ± 1.37 cm; P = .4593). After logistic regression, increased right wall length (OR 14.99; 95%CI 1.58-142.12) and transverse abdominal diameter (OR 9.33; 95%CI 1.13-76.68) was more likely to be observed in patients with midline hernias than in those with lateral locations.

CONCLUSIONS

Preoperative treatment with BT appears to be more effective in patients with midline hernias than in those with lateral locations.

摘要

引言

肉毒杆菌毒素（BT）的术前治疗在复杂切口疝中非常常见，尽管其缺乏明确的适应证。

方法

在2019年7月至2022年5月期间，我们从本院接受BT治疗前后的患者CT扫描中测量了腹壁外侧的厚度和长度、腹部横径以及疝缺损直径。为了确定外侧疝和中线疝患者之间的差异，进行了逻辑回归分析。

结果

该研究纳入了23例患者：17例为中线疝，6例为外侧疝（4例右侧，2例双侧）。我们观察到右侧壁长度增加（1.15±1.64厘米；P = 0.0029）、左侧壁长度增加（1.96±1.74厘米；P < 0.0001）以及腹部横径增加（2.85±4.83厘米；P < 0.0001），同时右侧壁厚度降低（-0.54±0.53厘米；P < 0.0001）和左侧壁厚度降低（-0.58±0.42厘米；P < 0.0001）。缺损的横径没有差异（-0.01±1.37厘米；P = 0.4593）。经过逻辑回归分析，与外侧疝患者相比，中线疝患者更有可能出现右侧壁长度增加（比值比14.99；95%置信区间1.58 - 142.12）和腹部横径增加（比值比9.33；95%置信区间1.13 - 76.68）。