腹横肌松解术在巨大腹壁疝修补中的应用价值  

Application value of transversus abdominis muscle release technique in giant ventral hernia repair

作　　者：靳翠红 王帆[1] 王宝山[1] 申英末[1] 袁昕 陈富强[1] Jin Cuihong;Wang Fan;Wang Baoshan;Shen Yingmo;Yuan Xin;Chen Fuqiang(Department of Hernia and Abdominal Wall Surgery,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100043,China)

机构地区：[1]首都医科大学附属北京朝阳医院疝和腹壁外科,100043

出　　处：《中华消化外科杂志》2021年第7期805-809,共5页Chinese Journal of Digestive Surgery

基　　金：北京市卫生系统高层次卫生技术人才培养计划(2015-3-031)。

摘　　要：目的探讨腹横肌松解术(TAR)在巨大腹壁疝修补中的应用价值。方法采用回顾性描述性研究方法。收集2017年1月至2020年1月首都医科大学附属北京朝阳医院收治的72例巨大腹壁疝病人临床资料;男47例,女25例;中位年龄为56岁,年龄范围为29~79岁。病人选择TAR行腹壁缺损修补,同时使用聚丙烯补片行腹膜前-肌后间隙加强修补。观察指标:(1)手术情况。(2)术后并发症情况。(3)疝相关生命质量情况。采取门诊及电话方式随访,于术后1个月、6个月及1年各随访1次,了解病人术后并发症发生情况,随访时间截至2021年1月。正态分布的计量资料以x±s表示,组内比较采用配对t检验。偏态分布的计量资料以M(范围)表示,计数资料以绝对数表示。结果(1)手术情况:72例巨大腹壁疝病人均施行TAR顺利完成腹壁缺损修补,同时使用聚丙烯补片行腹膜前-肌后间隙加强修补。72例病人手术时间为(105±46)min,术中出血量为(55±15)mL,补片大小为(680±225)cm^(2)。(2)术后并发症情况:72例病人术后随访12~48个月,中位随访时间为16个月。术后1周7例病人腹部CT检查结果显示发生血清肿,大小为(460±130)mm^(2),予以随诊观察;术后6个月上述病人腹部CT检查结果显示血清肿全部吸收。72例病人中,2例术后发生肠梗阻,考虑术后麻痹性肠梗阻,经保守治疗后于术后2周好转。随访期间72例病人均无手术部位感染、肠瘘及疝复发。(3)疝相关生命质量情况:72例病人术前、术后12个月疝相关生命质量调查评分分别为(40±12)分、(73±17)分,病人手术前后比较,差异有统计学意义(t=12.527,P<0.05)。结论TAR应用于巨大腹壁疝修补术中安全、有效,能够改善病人疝相关生命质量。Objective To investigate the application value of transversus abdominis muscle release technique in giant ventral hernia repair.Methods The retrospective and descriptive study was conducted.The clinical data of 72 patients with giant ventral hernia who were admitted to Beijing Chaoyang Hospital of Capital Medical University from January 2017 to January 2020 were collected.There were 47 males and 25 females,aged from 29 to 79 years,with a median age of 56 years.All patients underwent ventral hernia repair with transversus abdominis muscle release technique and preperitoneal/retro-muscular polypropylene mesh reinforcement.Observation indicators:(1)surgical situations;(2)postoperative complications;(3)hernia-related quality of life.Follow-up was conducted using outpatient examination and telephone interview to detect postoperative complications at postoperative 1,6 and 12 months.Follow-up was up to January 2021.Measurement data with normal distribution were represented as Mean±SD,and comparison within groups was analyzed using the paired t test.Measurement data with skewed distribution were represented as M(range).Count data were described as absolute numbers.Results(1)Surgical situations:all 72 patients underwent ventral hernia repair with transversus abdominis muscle release technique and preperitoneal/retro-muscular polypropylene mesh reinforcement successfully.The operation time,volume of intraoperative blood loss and mesh size of the 72 patients were(105±46)minutes,(55±15)mL and(680±225)cm^(2),respectively.(2)Postoperative complications:72 patients were followed up for 12 to 48 months,with a median follow-up time of 16 months.During the follow-up,7 of the 72 patients were diagnosed with seroma by abdominal computed tomography(CT)scan at postoperative 1 week,the size of which was(460±130)mm^(2).The 7 patients with seroma were followed up and results of abdominal CT scan at postoperative 6 months showed that the seroma was completely absorbed.Two of the 72 patients had postoperative intestinal obstruction,wh

关 键 词：疝 腹壁 巨大 腹横肌松解术 后组织结构分离技术 腹壁重建 

分 类 号：R656.2[医药卫生—外科学]