背景：发生切口疝（IH）的筋膜破裂是任何开腹手术的重要且具有挑战性的并发症。很长一段时间,腹壁重建术(AWR)的成功仅从外科医生的角度通过定义结局指标如伤口发病率和复发来衡量.完全康复很难在不考虑患者的情况下进行评估的理解已经将最佳结果的范式转变为患者报告的结果指标（PROMS）和生活质量（QoL）。这是评估AWR成功和疗效的关键。
方法：我们在2021年1月至2023年12月期间，对91例接受网片增强腹壁重建术治疗原发性或复发性切口疝的患者进行了前瞻性随访研究。人口统计数据,合并症,并记录疝特征。所有患者术前均通过天然腹部-盆腔CT扫描进行评估，以评估疝气的特征（长度，宽度,表面,以及切口疝囊和腹膜腔的体积），网格的存在（如果以前插入），和腹壁肌肉状态。所有干预均由同一手术团队根据Rives-Stoppa（RS）描述的技术进行，拉米雷斯（ACS），和Novitsky（PCS）。使用术前进行的躯干抬高（TR）和双腿降低（DLL）测量来评估腹壁功能，1个月,6个月,术后1年。同时,使用EQ-5D评分分析手术前后的生活质量。
结果：记录的平均年龄为59.42±12.28岁，男女比例为35/56，他们中的大多数都是肥胖的。有36例（42％）患者的缺损大于10cm。手术干预类型的分布为：RS35患者，ACS13例患者，和PCS43名患者。术前腹壁功能综合评分平均值为4.41±1.67(2～8),术前EQ-5D指数平均值为0.652±0.026(-0.32～1.00)。记录指标值小于0.56（50％百分位数）的患者中，有48％（44）的QoL差且非常差。术前EQ-5D指数与联合AWF评分高度相关（r=0.620；p<0.0001），且相关性具有特异性（AUC=0.799；p<0.0001；渐近95CI=0.711-0.923）。12个月时,AWF评分增至8.13±2.58(1-10),QoL总分增至0.979±0.007(0.71-1)。在术前评估中记录了47例患者（84％）的QoL总评分良好和非常好，而33例（36％）（采用Yates连续性校正的χ2=46.04；p<0.00001）。
结论：我们的结果表明，在Eq的帮助下，患者可以期望看到QoL的所有五个组成部分都有显着的总体改善。5D问卷。这种改善取决于疝的大小，和一些个体患者的因素(糖尿病，心血管疾病,年龄超过60岁)。
BACKGROUND: Fascial breakdown with the occurrence of an incisional hernia (IH) is an important and challenging complication of any laparotomy. For a long time, the success of the abdominal wall reconstruction (AWR) was measured only from the surgeon\'s perspective by defining outcome measures such as wound morbidity and recurrence. The understanding that complete recovery is difficult to assess without considering patients has shifted the paradigm of optimal outcomes to Patient Reported Outcome Measures (PROMS) and Quality of Life (QoL), which are pivotal to evaluate the success and efficacy of AWR.
METHODS: We conducted a prospective follow-up
study of 91 patients undergoing mesh-augmented abdominal wall reconstruction for primary or recurrent incisional hernia between January 2021 and December 2023. Demographic data, comorbidities, and hernia characteristics were recorded. All patients were evaluated preoperatively by a native abdomino-pelvic CT scan to assess the characteristics of hernia (length, width, surface, and volume of the incisional hernia sac and of peritoneal cavity), the presence of mesh (if previously inserted), and abdominal wall muscles status. All intervention were performed by the same surgical team according to the techniques described by Rives - Stoppa (RS), Ramirez (ACS), and Novitsky (PCS). Abdominal wall function was assessed using trunk raising (TR) and double leg lowering (DLL) measurements performed preoperatively, 1 month, 6 months, and 1 year postoperatively. At the same time, pre- and post-operative quality of life was analysed using the EQ-5D score.
RESULTS: Mean age of 59.42 ± 12.28 years and a male/female ratio of 35/56 were recorded, most of them being obese. There were 36 (42%) patients with defects larger than 10 cm. The distribution of the type of surgical intervention was: RS 35 patients, ACS 13 patients, and PCS 43 patients. The mean value of combined score for the preoperative abdominal wall functionality was 4.41 ± 1.67 (2-8) while the mean value of preoperative EQ-5D index was 0.652 ± 0.026 (-0.32-1.00). QoL was poor and very poor for 48% (44) of the patients who recorded index values less than 0.56 (50% percentile). Preoperative EQ-5D index was highly correlated with Combined AWF score (r = 0.620; p < 0.0001) and the correlation was specific (AUC = 0.799; p < 0.0001; asymptotic 95%CI = 0.711-0.923). At 12 months, the AWF score increased to 8.13 ± 2.58 (1-10) and the QoL total score to 0.979 ± 0.007 (0.71-1). Good and very good total scores for QoL were recorded for 47 patients (84%) compared to 33 (36%) in the preoperative evaluation (χ2 with Yates continuity correction for two degrees of liberty = 46.04; p < 0.00001).
CONCLUSIONS: Our results suggest that patients can expect to see a significant overall improvement in all five components of QoL measured with the help of Eq. 5D questionnaire. This improvement is dependent by hernia size, and some individual patient\'s factors (diabetes, cardiovascular diseases, and age over 60 years).
