Coelho J C, Brenner A S, Freitas A T, Campos A C, Wiederkehr J C
Department of Surgery of the Federal University of Paraná, Curitiba, Brazil.
Eur J Surg. 1993 Jun-Jul;159(6-7):339-41.
To present our experience of progressive preoperative pneumoperitoneum in the preparation of patients for repair of large hernias of the abdominal wall.
Prospective selected series.
A university hospital and a district hospital.
36 Patients of the 252 who presented for abdominal hernia repair between January 1977 and April 1992.
Air was insufflated into the peritoneal cavity through a 19 gauge spinal needle, and between 500 and 2000 ml was usually injected at the first session. Amounts were gradually increased daily or every other day for a period of 6-15 days; the total amount insufflated ranged from 4500-18,500 (mean 7700) ml.
Whether the hernia could be repaired directly without recourse to polypropylene mesh, complications of pneumoperitoneum, and recurrence rate.
In one patient air was insufflated into the colon, one developed temporary but severe respiratory distress, and 4 developed moderate subcutaneous emphysema. 30 hernias were repaired directly, and 6 required polypropylene mesh. There were three wound infections (two after direct repair), and two recurrences (both after direct repair). Mean length of follow up was 10 months (range 1-48).
Progressive preoperative pneumoperitoneum allows direct repair of some large abdominal hernias with a low recurrence rate, and few complications.
介绍我们在为腹壁大疝修补术患者做准备时进行渐进性术前气腹的经验。
前瞻性选择系列研究。
一所大学医院和一所地区医院。
1977年1月至1992年4月间前来进行腹部疝修补术的252名患者中的36名。
通过19号脊椎穿刺针将空气注入腹腔，首次注入量通常为500至2000毫升。此后每天或隔天逐渐增加注入量，持续6至15天；注入总量为4500至18500（平均7700）毫升。
疝能否直接修补而无需使用聚丙烯网片、气腹的并发症及复发率。
1例患者空气注入结肠，1例出现短暂但严重的呼吸窘迫，4例出现中度皮下气肿。30例疝直接修补，6例需要聚丙烯网片。有3例伤口感染（2例在直接修补后），2例复发（均在直接修补后）。平均随访时间为10个月（范围1至48个月）。
渐进性术前气腹可使部分大型腹部疝得以直接修补，复发率低且并发症少。
