Bauer J J, Harris M T, Kreel I, Gelernt I M
Department of Surgery, Mount Sinai School of Medicine, New York, NY, USA.
Mt Sinai J Med. 1999 Jan;66(1):20-5.
A prosthetic device must be used to repair ventral hernias in patients with insufficient tissue for a tension-free primary closure. Several prosthetic materials have been employed for this purpose, with varying results. We here review a long experience with the use of expanded polytetrafluoroethylene (ePTFE) patches in the open repair of large abdominal wall defects.
Demographic, operative, follow-up, and histologic data were recorded and analyzed for all patients in a surgical practice who were treated for large abdominal wall defects with open repair using ePTFE patches between November 1983 and March 1996.
Ventral hernia repairs using an ePTFE patch were performed in 98 patients. In 48 (49%), the patient had already undergone at least one previous ventral hernia repair. Of the 98 operations, 78 were full-thickness repairs, 11 were Rives-Stoppa procedures, and 9 were onlay operations. Complications included 5 seromas, 3 fistulas related to removal of a previously implanted prosthesis, and 9 infections. In addition, 10 patients developed recurrent hernias not related to explantation of the patch because of infection or fistula. In 3 patients, infections were treated successfully without removal of the patch. There were no complications related to adhesions, erosion of the patch into the viscera, or bowel obstruction. Histologic studies of longterm ePTFE implants showed excellent fibrous tissue ingrowth and minimal foreign body response.
Our long-term clinical experience indicates that prosthetic patches of ePTFE are safe and effective when used in the repair of large abdominal wall defects that cannot be closed primarily. Operative complications were within acceptable limits, as was the reherniation rate.
对于组织不足以进行无张力一期缝合的患者，必须使用假体装置来修复腹疝。为此已采用了几种假体材料，结果各不相同。我们在此回顾使用膨体聚四氟乙烯（ePTFE）补片开放修复大腹壁缺损的长期经验。
记录并分析了1983年11月至1996年3月期间在一家外科诊所接受治疗的所有患者的人口统计学、手术、随访和组织学数据，这些患者均使用ePTFE补片进行大腹壁缺损的开放修复。
98例患者使用ePTFE补片进行了腹疝修复。其中48例（49%）患者此前至少已接受过一次腹疝修复。在这98例手术中，78例为全层修复，11例为里夫斯 - 斯托帕手术，9例为覆盖修补术。并发症包括5例血清肿、3例与取出先前植入的假体相关的瘘管以及9例感染。此外，10例患者因感染或瘘管出现与补片取出无关的复发性疝。3例患者在未取出补片的情况下成功治疗了感染。未出现与粘连、补片侵蚀内脏或肠梗阻相关的并发症。对长期植入ePTFE的组织学研究显示纤维组织向内生长良好且异物反应极小。
我们的长期临床经验表明，ePTFE假体补片用于修复无法一期缝合的大腹壁缺损时安全有效。手术并发症在可接受范围内，复发率也是如此。
