定义,直肌舒张(RD)的分类和处理在文献中存在争议,并且已经描述了各种不同的手术治疗方法。本文报道了欧洲疝学会(EHS)RD临床实践指南。
指南组由8名外科医生组成。建议的分级,评估,使用了开发和评估(等级)方法以及研究和评估指南(AGREE)工具。2018年11月进行了系统的文献检索,并于2019年11月和2020年10月进行了更新。制定了九个关键问题(KQs)。
有关定义的文献报道,分类,症状,结果和治疗质量有限,导致大多数KQ的建议薄弱。主要建议将RD定义为宽度超过2厘米的直肌之间的间隔。提出了一种基于肌肉分离宽度的新分类系统,妊娠后的状态以及是否伴有疝气。身体形象受损和核心不稳定似乎是最相关的症状。手术前可考虑物理治疗。建议在没有并发疝的患者中使用白线折叠术,并对并发中线疝的RD进行基于网片的修复。
RD应定义为宽度超过2cm的直肌分离,并建议采用新的分类系统。
RD的管理是有争议的。这些指南旨在就确切的定义达成共识,正确的测量和诊断方法,一个分类系统,主要症状,以及对非手术和手术治疗的系统评价,以达到该病理患者的最佳效果。主要建议将RD定义为宽度超过2厘米的直肌之间的间隔。提出了一种新的分类系统。建议在没有并发疝气的患者中使用白线折叠术,在并发中线疝的患者中使用基于网状的RD修复术。
The definition, classification and management of rectus diastasis (RD) are controversial in the literature and a variety of different surgical treatments have been described. This article reports on the European Hernia Society (EHS) Clinical Practice
Guideline for RD.
The
Guideline group consisted of eight surgeons. The Grading of Recommendation, Assessment, Development and Evaluation (GRADE) approach and the Appraisal of
Guidelines for Research and Evaluation (AGREE) instrument were used. A systematic literature search was done in November 2018 and updated in November 2019 and October 2020. Nine Key Questions (KQs) were formulated.
Literature reporting on the definition, classification, symptoms, outcomes and treatments was limited in quality, leading to weak recommendations for the majority of the KQs. The main recommendation is to define RD as a separation between rectus muscles wider than 2 cm. A new classification system is suggested based on the width of muscle separation, postpregnancy status and whether or not there is a concomitant hernia. Impaired body image and core instability appear to be the most relevant symptoms. Physiotherapy may be considered before surgical management. It is suggested to use linea alba plication in patients without concomitant hernia and a mesh-based repair of RD with concomitant midline hernias.
RD should be defined as a separation of rectus muscles wider than 2 cm and a new classification system is suggested.
The management of RD is controversial. These
guidelines are intended to provide a
consensus about the exact definition, the correct way of measurement and diagnosis, a classification system, the main symptoms, and a systematic review of non-surgical and surgical treatments to achieve the best results for patients with this pathology. The main recommendation is to define RD as a separation between rectus muscles wider than 2 cm. A new classification system is proposed. It is suggested to use linea alba plication in patients without concomitant hernia and a mesh-based repair of RD in those with concomitant midline hernias.