坏死性胰腺炎术后影响切口疝发生的因素分析  

Analysis of factors on influencing factors in the occurrence of incisional hernia after the operation of necrotizing pancreatitis

作　　者：崔凯[1] 姜博伦 

机构地区：[1]沈阳医学院附属中心医院普外科,辽宁沈阳110024 [2]第二军医大学

出　　处：《岭南现代临床外科》2014年第5期519-522,共4页Lingnan Modern Clinics in Surgery

摘　　要：目的坏死性胰腺炎(NP)患者经常需要胰腺清创,并且有发生切口疝(IH)的风险。然而,目前尚未见关于坏死性胰腺炎中切口疝发生率的相关报道。我们研究的目的是明确其发病率,并且确定胰腺清创后IH发生的危险因素。方法通过临床查体及病人访谈确定IH的存在。技术及临床方面的数据包括:切口类型,关腹方式,缝线材料,年龄,身体质量指数(BMI),糖尿病(DM),术前白蛋白水平及手术次数。结果 149例胰腺清创患者中63例(42%)发生了IH,且IH患者多为老年(P<0.05)。在外科手术方式或临床危险因素方面组间未见差异。结论需要手术清创的NP患者IH的发病率要显著高于常规剖腹探查者。具有创新性的筋膜关闭技术,如非合成补片进行初次手术筋膜支撑,应予关注。Objective Necrotizing pancreatitis （NP） patients frequently underwent pancreatic debr-idement with risk factors for ineisional hernia （IH）. However, no published data exist the regarding incidence of IH in NP. The aim of the current study was to define the incidence of and identify risk factors for developing IH after pancreatic dehridement. Methods Hemia presence was determined by clinical examination and patient interview. Technical and clinical considerations were noted： type of incision, closure, suture material, age, body mass index （BMI）, diabetes mellitus （DM）, preoperative albumin, and number of operations. Results Sixty-three （42%） of 149 debrided patients with NP developed IH. IH patients were older than those without IH（P〈0.05 ）. No differences in surgical technique or clinical risk factors were seen between groups. Conclusion The incidence of IH in NP patients requiring operative debridement is substantially higher than that in patients undergoing routine laparotomy. Innovative fascial closure techniques such as primary faseial buttress with nonsynthetic mesh should be considered.

关 键 词：切口疝 腹壁疝 危险因素 坏死性胰腺炎 胰腺清创 

分 类 号：R657.51[医药卫生—外科学] R656.2[医药卫生—临床医学]