Complex ventral hernia

复杂性腹侧疝
  • 文章类型: Journal Article
    背景:大型腹侧疝(VH)的手术治疗仍然是一个挑战。已经采用了各种技术,例如具有腹横肌释放(TAR)的前成分分离和后成分分离(PCS)。尽管最初取得了成功,TAR的长期疗效尚未全面研究。作者旨在调查早期的,medium-,以及接受PCS和TAR治疗的患者的长期结局和健康相关生活质量(QoL)。
    方法:这项多中心回顾性研究分析了在2015年至2020年期间因原发性或复发性复杂性腹部疝接受TAR开放式PCS治疗的308例患者的数据。主要终点是3、6、12、24和36个月时的疝复发率(HR)和网片膨出率(MB)。次要结局包括手术部位事件和QoL,使用EuraHS-QoL评分进行评估。
    结果:平均随访38.3±12.7个月。总体HR率为3.5%,MB率为4.7%。大多数复发是通过临床和超声检查发现的。QoL指标显示术后改善。
    结论:本研究支持PCS联合TAR治疗大且复杂VH的长期疗效,复发率低,QoL改善。需要进一步的研究才能更深入地了解这些结果及其影响因素。
    BACKGROUND: Surgical management of large ventral hernias (VH) has remained a challenge. Various techniques like anterior component separation and posterior component separation (PCS) with transversus abdominis release (TAR) have been employed. Despite the initial success, the long-term efficacy of TAR is not yet comprehensively studied. Authors aimed to investigate the early-, medium-, and long-term outcomes and health-related quality of life (QoL) in patients treated with PCS and TAR.
    METHODS: This multicenter retrospective study analyzed data of 308 patients who underwent open PCS with TAR for primary or recurrent complex abdominal hernias between 2015 and 2020. The primary endpoint was the rate of hernia recurrence (HR) and mesh bulging (MB) at 3, 6, 12, 24, and 36 months. Secondary outcomes included surgical site events and QoL, assessed using EuraHS-QoL score.
    RESULTS: The average follow-up was 38.3 ± 12.7 months. The overall HR rate was 3.5% and the MB rate was 4.7%. Most of the recurrences were detected by clinical and ultrasound examination. QoL metrics showed improvement post-surgery.
    CONCLUSIONS: This study supports the long-term efficacy of PCS with TAR in the treatment of large and complex VH, with a low recurrence rate and an improvement in QoL. Further research is needed for a more in-depth understanding of these outcomes and the factors affecting them.
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  • 文章类型: Journal Article
    背景:大型腹壁疝通常需要壁扩张技术来改善手术效果。腹膜瓣疝修补术(PF)是一种利用疝囊重建腹壁的技术,然而,发布的数据有限。这是Rives-Stoppa网片修复的一种改进,其中一部分平分的疝囊用于重建前筋膜,另一部分用于后筋膜。我们对复杂腹侧疝患者进行有或没有腹横肌释放(TAR)的三个中心的结果进行了回顾性分析。
    方法:对切口疝患者进行PF,中线和横向。测量的主要结果是疝复发。次要结果是评估疼痛,手术部位感染,血清肿,血肿,伤口裂开,假性复发,Clavien-Dindo并发症评分,和患者报告的生活质量。在随访期间通过口服问卷评估生活质量。
    结果:我们分析了63例患者(38例女性,25名男性),疝缺损的平均宽度为11cmSD4。根据欧洲疝学会(EHS)分类,42例患者为W3,21例为W2疝。50个病人有中线疝,而其余的患者包括横纹肌,肋下,和屋顶切口疝。在29例(46%)患者中进行了经典的腹膜瓣手术,34例(54%)患者进行了TAR腹膜瓣。4例患者出现有症状的血清肿(6%),7例浅表手术部位感染(SSI)(11%),一个深度SSI(1.5%),1例皮肤坏死(1.5%),腹膜前皮瓣坏死1例(1.5%)。没有患者需要术后通气支持。第一天的平均疼痛评分为3/10。在平均17个月(5至49个月)的随访中没有复发。总的来说,63例患者中有58例(92%)报告对他们的手术感到满意。
    结论:在我们的多中心研究中,我们发现,无论有无TAR的PF技术治疗中线和非中线腹侧疝均可在低复发方面获得满意的结果,并发症发生率低,以及中长期的良好生活质量。在外科医生的医疗设备中,这似乎是一种有用的技术,可以修复需要腹域扩张的W2和W3疝。
    BACKGROUND: Large abdominal wall hernias often require techniques for wall expansion to improve surgical outcomes. The peritoneal flap hernioplasty (PF) is one such technique that utilizes the hernia sac to reconstruct the abdominal wall, however, with limited published data. It is a modification of the Rives-Stoppa mesh repair where a part of the bisected hernia sac is utilized to reconstruct the anterior fascia and the other part for the posterior fascia. We present a collated retrospective analysis of the outcomes from three centers performing PF with or without transverse abdominis release (TAR) in patients with complex ventral hernias.
    METHODS: The PF was performed in patients with incisional hernias, both midline and lateral. The primary outcome measured was hernia recurrence. The secondary outcomes were to evaluate pain, surgical site infection, seroma, hematoma, wound dehiscence, pseudo-recurrence, Clavien-Dindo score for complications, and the patient\'s reported quality of life. The quality of life was assessed by oral questionnaires in the follow-up period.
    RESULTS: We analyzed 63 patients (38 female, 25 male) with a mean width of hernia defect of 11 cm SD 4. Based on the European Hernia Society (EHS) classification 42 patients were W3 and 21 were W2 hernias. Fifty patients had a midline hernia, while the rest of the patients included transverse, subcostal, and rooftop incision hernias. The classical peritoneal flap procedure was done in 29 (46%) patients, while the peritoneal flap with TAR was done in 34 (54%) patients. Four patients had symptomatic seroma (6%), seven superficial surgical site infection (SSI) (11%), one deep SSI (1.5%), one skin necrosis (1.5%), and one anterior peritoneal flap necrosis (1.5%). No patient required postoperative ventilatory support. The mean pain score on day one was 3/10. There was no recurrence in the mean follow-up of 17 months (range 5 to 49 months). Overall, 58 of 63 (92%) patients reported being satisfied with their surgery.
    CONCLUSIONS: In our multicentre study, we found the PF technique with or without TAR for midline and non-midline ventral hernia leads to satisfactory outcomes in terms of low recurrence, low rate of complications, and a good quality of life in the medium to long term. It appears to be a useful technique in the surgeon\'s armamentarium to repair W2 and W3 hernias needing expansion of abdominal domain.
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  • 文章类型: Journal Article
    背景:在患有大型腹侧疝的患者中,向外部和内部斜肌的肉毒杆菌毒素减少厚度并增加长度。我们根据两个比率和疝气大小检查了肉毒杆菌毒素对结构域丢失量的影响。
    方法:在2021年10月至2023年11月之间,对20例水平尺寸为10厘米或以上的腹侧疝患者在手术前4周向每个外部和每个内部斜肌施用50单位肉毒杆菌毒素。切口疝体积与腹膜体积之比,体积比,比较注射肉毒毒素前和注射后4周的疝大小。使用配对t检验或Wilcoxon符号秩检验进行在施用肉毒杆菌毒素之前和之后获得的所有变量之间的比较。Pearson相关系数用于分析初始条件与注射肉毒杆菌毒素后观察到的进一步变化之间的关联。
    结果:我们观察到肌肉振幅减少了42%,腹内容积增加16%,疝体积减少28%,IHV/PV比下降6%,V比下降11%,疝宽度减少11%,矩形和椭圆形疝区域减少10%。
    结论:在大型腹侧疝患者中,肉毒杆菌毒素与疝气大小的减小和结构域丢失的减少有关,当少于10%的内脏块突出时,后者并不重要。
    In patients with large ventral hernias, botulinum toxin to external and internal oblique muscles decreases thickness and increases length. We examined the impact of botulinum toxin in the amount of loss of domain according to two ratios and in hernia size.
    Between October 2021 and November 2023, 20 patients with ventral hernias measuring 10 cm or more on the horizontal size underwent the administration of 50 units of botulinum toxin to each external and each internal oblique muscle 4 weeks before their surgery. Incisional hernia volume to peritoneal volume ratio, volume ratio, and hernia size were compared before and 4 weeks after the injection of botulinum toxin. Comparisons between all variables obtained before and after the administration of botulinum toxin were performed using either the paired t-test or the Wilcoxon signed-rank test. Pearson correlation coefficient was used to analyze associations between initial conditions and further changes observed after botulinum toxin injection.
    We observed a 42% reduction in muscle amplitude, 16% increase in intra-abdominal volume, 28% decrease in herniated volume, decreases of 6% in IHV/PV ratio and of 11% in V ratio, 11% reduction of hernia width, and decrease of 10% in rectangular and elliptical hernia areas.
    In patients with large ventral hernias, botulinum toxin is associated with reduction of hernia size and decrease in loss of domain, the latter not being significant when less than 10% of the visceral block is herniated.
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  • 文章类型: Journal Article
    目标:不可否认,在过去的20年里,腹壁修复领域的手术方法有了显著改善。然而,提供低发病率的持久修复的最佳方法尚未确定。这项研究的目的是概述我们在复杂腹侧疝患者的横向腹肌释放(TAR)方法后的长期结果,关注术后复发率和患者总体满意度。
    方法:这是一项回顾性研究,研究对象是在2015年1月至2021年12月期间因原发性或复发性复杂性腹部疝接受TAR的167例连续患者。其中,选择并分析了117例使用双网(可吸收和永久性合成网)进行开放式马德里入路的患者。使用生活质量问卷(EuraHSQoL)比较术前和术后状态。
    结果:在2015年1月至2021年12月之间,我们使用双网状技术(可吸收和永久性合成网状物)成功治疗了117例表现为复杂腹侧缺损的患者。其中,26例(22.2%)为复发病例。中位随访期为37.7个月,有1例(0.8%)复发和8例(6.8%)隆起。在美容方面,与术前状态相比,QoL评分显着提高,身体感知,和身体不适。
    结论:马德里入路的后部组件分离与低的围手术期发病率和复发率相关。根据其他研究,我们证明了根据马德里方法进行重建的TAR在治疗复杂的腹壁疝方面提供了出色的结果,即使是长期随访。
    OBJECTIVE: Undeniably, in the last 2 decades, surgical approaches in the field of abdominal wall repair have notably improved. However, the best approach to provide a durable repair with low morbidity rate has yet to be determined. The purpose of this study is to outline our long-term results following the Transverse Abdominis Release (TAR) approach in patients with complex ventral hernias, focusing on the incidence of recurrence and overall patient satisfaction following surgery.
    METHODS: This is a retrospective study on 167 consecutive patients who underwent TAR between January 2015 and December 2021 for primary or recurrent complex abdominal hernias. Of these, 117 patients who underwent the open Madrid approach with the use of a double mesh (absorbable and permanent synthetic mesh) were selected and analyzed. A quality of life questionnaire (EuraHS QoL) comparing the preoperative and the postoperative status was administered.
    RESULTS: Between January 2015 and December 2021, we successfully treated 117 patients presenting with complex ventral defects using the double mesh technique (absorbable and permanent synthetic mesh). Of these, 26 (22.2%) were recurrent cases. At a median follow-up period of 37.7 months, there had been 1 (0.8%) case of recurrence and 8 cases (6.8%) of bulging. The QoL score was significantly improved when compared to the preoperative status in terms of cosmesis, body perception, and physical discomfort.
    CONCLUSIONS: The Madrid approach for posterior component separation is associated with both a low perioperative morbidity and recurrence rate. In accordance with other studies, we demonstrated that the TAR with reconstruction according to the Madrid approach provides excellent results in the treatment of complex abdominal wall hernias, even at long-term follow-up.
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  • 文章类型: Journal Article
    目的:A型肉毒杆菌毒素(BTA)是一种辅助工具,用于腹壁重建(AWR)前复杂疝的术前优化。本研究旨在研究BTA应用后腹腔和疝囊尺寸的变化。
    方法:一项前瞻性研究,对27例疝缺损≥10cm且区域丢失(LOD)≥20%的患者进行了AWR。在应用BTA之前和之后进行计算机断层扫描(CT)测量和体积测定。评估术中和术后结果。
    结果:BTA后成像显示疝宽度减少1.9cm(p=0.002),外侧腹壁肌肉伸长3.1cm(p<0.001),疝体积减少(HV)从2.9±0.9L到2.4±0.8L(p<0.001),腹腔容积(ACV)从9.7±2.5L增加到10.3L±2.4L(p=0.003),HV/ACV比从30.2±5%降低到23.4±6%(p<0.001)。92.6%的病例实现了筋膜闭合,而78%的病例需要进行成分分离。肺动脉压力的平均变化为3.53cmH2O,并且没有记录到术后呼吸衰竭。在90天的随访中,伤口发病率为25%,计划外再入院的比例为11%,疝复发7.4%。
    结论:BTA可在腹壁产生可测量的体积变化,并有助于筋膜闭合。需要进一步的研究来确定BTA在复杂疝修补手术中的作用。
    OBJECTIVE: Botulinum toxin type A (BTA) is an adjuvant tool used in the preoperative optimization of complex hernias before abdominal wall reconstruction (AWR). This study aims to investigate changes in the abdominal cavity and hernia sac dimensions after BTA application.
    METHODS: A prospective study with 27 patients with a hernia defect of ≥ 10 cm and loss of domain (LOD) ≥ 20% underwent AWR. Computed tomography (CT) measurements and volumetry before and after the application of BTA were performed. Intraoperative and postoperative outcomes were evaluated.
    RESULTS: Imaging post-BTA revealed hernia width reduction of 1.9 cm (p = 0.002), lateral abdominal wall muscle elongation of 3.1 cm (p < 0.001), hernia volume reduction (HV) from 2.9 ± 0.9L to 2.4 ± 0.8L (p < 0.001), increase in abdominal cavity volume (ACV) from 9.7 ± 2.5L to 10.3L ± 2.4L (p = 0.003), and a reduction in the HV/ACV ratio from 30.2 ± 5% to 23.4 ± 6% (p < 0.001). Fascial closure was achieved in 92.6% of cases and component separation was required in 78%. The average variation in pulmonary plateau pressure was 3.53 cmH2O, and there were no postoperative respiratory failure recorded. At the 90-day follow-up, the wound morbidity rate was 25%, unplanned readmissions were 11%, and hernia recurrence 7.4%.
    CONCLUSIONS: BTA produces measurable volumetric changes in abdominal wall and appears to facilitate fascial closure. Further studies are required to determine the role of BTA in the surgical armamentarium for complex hernia repair.
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  • 文章类型: Journal Article
    背景:对于任何外科医生来说,复杂的腹侧疝仍然是一个具有挑战性的情况。在这项研究中,我们的目的是分析腹腔镜腹膜内嵌网(IPOM)修补术治疗复杂性腹壁疝的效果,在术前进行性气腹(PPP)和肉毒杆菌毒素A(BTA)的协助下。方法:在这项回顾性研究中,我们纳入了2021年5月至2022年12月期间的13例复杂性腹疝患者.所有患者在疝修补术前接受PPP和BTA方案。通过CT扫描测量腹壁肌肉的长度和腹围。所有疝均采用腹腔镜或腹腔镜辅助IPOM修复。结果:13例患者接受了PPP和BTA注射。PPP和BTA给药时间超过8.8±2.5天。在PPP和BTA之前和之后,影像学显示两侧外侧肌的长度从14.3cm增加到17.4cm(P<.05)。腹围从81.8cm增加到87.9cm(P<.05)。13例患者(100%)获得完全筋膜闭合,没有患者出现术后腹部高血压和通气支持。迄今为止,没有患者患有复发性疝气。结论:术前PPP联合BTA注射起到类似成分分离技术的作用,避免了腹腔镜下复杂腹侧疝IPOM修补术后的腹腔高压。
    Background: Complex ventral hernia remains a challenging situation for any surgeon. In this study, our aim was to analyze the effect of laparoscopic intraperitoneal onlay mesh (IPOM) repair in the treatment of complex abdominal wall hernia, with the assistance of preoperative progressive pneumoperitoneum (PPP) and botulinum toxin A (BTA). Methods: In this retrospective study, we included 13 patients with complex ventral hernia between May 2021 and December 2022. All patients undergoing PPP and BTA protocol before hernia repair. The length of abdominal wall muscles and abdominal circumference were measured from CT scan. All hernias were repaired with laparoscopic or laparoscopic-assisted IPOM. Results: Thirteen patients received PPP and BTA injections. PPP and BTA administration time was over 8.8 ± 2.5 days. Before and after PPP and BTA, imaging showed that the length of lateral muscle on each side increased from 14.3 to 17.4 cm (P < .05). The abdominal circumference increased from 81.8 to 87.9 cm (P < .05). Complete fascial closure was obtained in 13 patients (100%), and no patient experienced postoperative abdominal hypertension and ventilatory support. No patient suffered from recurrent hernia to date. Conclusions: Preoperative PPP combined with BTA injection plays a role similar to component separation technique, avoids the abdominal hypertension after laparoscopic IPOM repair of complex ventral hernia.
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  • 文章类型: Case Reports
    There is no generally accepted incisional hernia classification. To categorize incisional hernias, the European Hernia Society (EHS) proposed their classification based on the measurement of three parameters - location, dimension of hernia gate and recurrence. Unfortunately, this classification does not consider the «loss of the domain» of 20% or more, local complications including trophic ulcer or fistula of anterior abdominal wall. Moreover, implantation of mesh after previous hernia repair, obesity and other clinical factors are also not considered. Thus, surgeons have recently allocated patients with complex incisional hernia in a separate group. There is no clear definition of this term. There are no clinical guidelines on the management of patients with these hernias, and the choice of optimal surgical treatment remains individual. The authors present a patient with complex incisional hernia. Surgical strategy is described.
    В настоящий момент не существует общепринятой классификации послеоперационных вентральных грыж. В 2009 г. рабочая группа Европейского общества герниологов (European Hernia Society — EHS) предложила классификацию, в основе которой лежит измерение 3 параметров: локализации, ширины грыжевых ворот и наличия рецидива. К сожалению, эта классификация не учитывает «потерю домена», наличие местных осложнений со стороны основного заболевания, таких как трофическая язва или свищ передней брюшной стенки. Не принимаются во внимание и использование эндопротеза после предыдущих герниопластик, наличие ожирения у пациента и многие другие факторы. С учетом этого в последние годы хирурги все чаще выделяют еще одну особую группу пациентов, определяя характер дефекта как «сложная грыжа передней брюшной стенки». Пока нет четкого определения этого термина. Клинических рекомендаций по лечению данного вида грыж нет, выбор оптимального оперативного лечения остается индивидуальным. Приводим клиническое наблюдение пациента со сложной послеоперационной вентральной грыжей. Описан и обоснован возможный вариант хирургической тактики лечения.
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  • 文章类型: Journal Article
    复杂切口疝(IH)患者是外科医生在日常实践中面临的一个不断增长且具有挑战性的类别,对大多数人来说确实是一个技术挑战。TAR的后部组件分离(PCS-TAR)已成为修复大多数复杂腹壁缺损的首选方法,包括那些失去域名的人,剑突下,肋下,造口旁或创伤和败血症后,最初接受“开放腹部”治疗,以及在未进行筋膜闭合以避免腹腔室综合征的情况下。最近的研究表明,PCS-TAR代表了复发性IH的有效程序。我们研究的目的是评估PCS-TAR的可重复性,描述我们的经历,我们的手术技术以及一组连续患者的术后并发症和复发率。连续52例复杂IH患者,2014年5月至2019年11月在那不勒斯的“Betania医院和OspedaledelMare医院”接受PCS-TAR的患者从前瞻性维护的数据库中进行鉴定,并进行了回顾性审查.有36名男性(69%)和16名女性(31%),平均年龄为57.88(范围39-76),体重指数(BMIkg/m2)为31.2(24-45)。超过一半的患者(58%)是活跃的吸烟者。平均缺损宽度为13.6cm(范围6-30),并且平均缺损面积为约267.9cm2。平均手术时间为228分钟。所有病例均达到后筋膜闭合,而前筋膜闭合仅29例(56%)。平均住院时间为5.7天。27%的患者出现轻微并发症(Clavien-DindoI-II级)和1例(1.9%)主要并发症(Clavien-DindoIII)。在23%的病例中登记了血清腺瘤。据报道,SSI为3.8%,没有深部伤口感染。平均随访28个月,复发率为1.9%。在单变量分析中,Bio-A表面>600cm2和排出时的引流管去除与主要并发症显着相关。而在多变量分析中,仅Bio-A表面>600cm2是相关的。考虑到复发的单变量分析,排水沟数量,SSO,Clavien-Dindo评分>2和缺损面积与复发显著相关,而在多变量分析中,没有变量相关。PCS-TAR是治疗与低SSO和复发率相关的复杂腹侧疝不可或缺的工具。烟草使用,肥胖和合并症不能视为PCS-TAR的绝对禁忌症.围手术期和术后并发症和引流的管理对短期结果有影响。基于这些结果,腹横肌释放后成分分离已成为我们治疗复杂腹侧疝患者的首选方法,需要在选定的患者中进行开放式疝修补术。
    Patients with complex incisional hernia (IH) is a growing and challenging category that surgeons are facing in daily practice and represent indeed a technical challenge for most of them. The posterior component separation with TAR (PCS-TAR) has become the procedure of choice to repair most complex abdominal wall defects, including those with loss of domain, subxiphoid, subcostal, parastomal or after trauma and sepsis treated initially with \"open abdomen\" and in those scenarios in which the fascia closure was not performed to avoid an abdominal compartment syndrome. Most recent studies showed that the PCS-TAR represents a valid procedure in recurrent IH. The purpose of our study is to evaluate the reproducibility of the PCS-TAR, describing our experience, our surgical technique and the rate of postoperative complications and recurrences in a cohort of consecutive patients. 52 consecutive patients with complex IH, who underwent PCS-TAR at \"Betania Hospital and Ospedale del Mare Hospital\" in Naples between May 2014 and November 2019 were identified from a prospectively maintained database and reviewed retrospectively. There were 36 males (69%) and 16 females (31%) with a mean age of 57.88 (range 39-76) and Body mass index (BMI kg/m2) of 31.2 (24-45). More than half of patients (58%) were active smokers. Mean defect width was 13.6 cm (range 6-30) and mean defect area was about 267.9 cm2. Mean operative time was 228 min. Posterior fascial closure was reached in all cases, while anterior fascial closure only in 29 cases (56%). Mean hospital stay was 5.7 days. 27% of patients developed minor complications (Clavien-Dindo grade I-II) and one case (1.9%) major complication (Clavien-Dindo III). Seroma was registered in 23% of cases. SSI was reported to be 3.8% with no deep wound infection. Recurrence rate was 1.9% in a mean follow-up of 28 months. In Univariate analysis Bio-A surface > 600 cm2 and drain removal at discharge were significantly associated with major complications, while in a multivariate analysis only Bio-A surface > 600 cm2 was related. Considering univariate analysis for recurrences, number of drains, SSO, Clavien-Dindo score > 2 and defect area were significantly associated with recurrence, while in a multivariate analysis no variables were related. PCS-TAR is an indispensable tool in managing complex ventral hernias associated with a low rate of SSO and recurrence. Tobacco use, obesity and comorbidities cannot be considered absolute contraindications to PCS-TAR. Peri and postoperative management of complications and drainages have an impact on short term outcomes. Based on these outcomes, posterior component separation with transversus abdominis release has become our method of choice for the management of patients with complex ventral hernia requiring open hernia repair in selected patients.
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  • 文章类型: Journal Article
    随着腹壁重建术的推进,更复杂的疝气患者正在接受修补术,可能需要接受术后外科重症监护病房(SICU)治疗.疝囊与腹腔的体积比(VR)是一种易于量化疾病严重程度和随之而来的生理损伤的方法。这项研究旨在使用VR和其他术前变量来预测术后SICU的入院情况。
    对2014年9月至2019年10月接受大型腹部疝(宽度≥18cm)修复的患者进行了单中心回顾性研究。患者人口统计学,合并症,腹部手术史,通过单变量和多变量方法分析和VR,以确定术后前2天内SICU入院的预测因素.生成并验证了预测模型。
    在符合纳入标准的434名患者中,127(29%)在术后前两天内需要SICU入院。SICU患者的VR明显更高(中位数30.6%[IQR14.4-59.0]vs.10.6%[IQR4.35-23.6],P<0.001)。男性,慢性阻塞性肺疾病史,在组件分离之前,复发性切口疝,疝气3级和VR显示SICU入院的几率较高。在测试数据集上验证时,这些变量显示了强大的SICU入院预测,曲线下有一个面积,灵敏度,特异性分别为0.82、81.7%和68.5%,分别。
    体积比与术前可用变量相结合可以可靠地预测腹壁重建后的术后SICU入院。术前预测此类事件可以分配床位空间并优化术后护理。
    With the advancement of abdominal wall reconstruction, more complex hernia patients are undergoing repairs that may require a postoperative surgical intensive care unit (SICU) admission. The volume ratio (VR) of the hernia sac to the abdominal cavity is an easily applied method to quantify disease severity and the ensuing physiologic insult. This study aimed to predict postoperative SICU admission using VR and other preoperative variables.
    A single-center retrospective review was conducted for patients undergoing large abdominal hernias (width ≥ 18 cm) repaired from September 2014 to October 2019. Patient demographics, comorbidities, abdominal surgical history, and VR were analyzed through univariate and multivariable methods to identify predictors of SICU admission within the first two postoperative days. A predictive model was generated and validated.
    Of 434 patients meeting inclusion criteria, 127(29%) required a SICU admission within the first two postoperative days. VR was significantly higher in SICU patients (Median 30.6% [IQR 14.4-59.0] vs. 10.6% [IQR 4.35-23.6], P < 0.001). Male sex, history of chronic obstructive pulmonary disease, prior component separation, recurrent incisional hernia, hernia grade 3, and VR showed higher odds of SICU admission. When validated on a testing dataset, these variables showed strong SICU admission predictions, with an area under the curve, sensitivity, and specificity of 0.82, 81.7% and 68.5%, respectively.
    The volume ratio in combination with preoperatively available variables can reliably predict postoperative SICU admission following abdominal wall reconstruction. Anticipating such events preoperatively allows for bed space allocation as well as optimizing postoperative care.
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  • 文章类型: Journal Article
    UNASSIGNED:任何复杂的腹侧疝的成功修复都需要对潜在的解剖缺陷及其功能背景有透彻的了解。我们描述了一种改进的腹壁CT成像的“功能”方法,可以促进这种理解并协助手术计划。
    UNASSIGNED:这篇特邀文章报道了88例患者的功能性腹壁CT检查的观察经验,这些患者使用术前肉毒杆菌毒素A(BTA)浸润腹侧斜肌进行了复杂的腹侧疝修补术,以及另外8例经检查排除腹侧疝的腹直肌扩张患者。
    UNASSIGNED:使用功能性CT方案补充静息图像和额外的“挤压”图像(腹壁肌肉全部强烈收缩而获得)可以显着改善腹壁疝缺损的表现。紧缩的收购也可以帮助区分真正的疝气和功能失调的凸起,识别肌肉神经支配或萎缩性变化,仅在静息或Valsalva图像上可能会遗漏的隐匿性疝,并协助术前评估BTA效果。
    UNASSIGNED:对腹壁进行术前CT成像的更多功能方法可以显着提高对复杂腹侧疝缺损的认识,并有助于制定有效的手术计划,从而实现低复发率和良好的功能结果。
    UNASSIGNED: The successful repair of any complex ventral hernia requires a thorough understanding of the underlying anatomical defect and its functional context. We describe an improved \"functional\" approach to CT imaging of the abdominal wall that can facilitate this understanding and assist surgical planning.
    UNASSIGNED: This invited article reports the observational experience gained from the functional abdominal wall CT examinations of 88 patients who underwent complex ventral hernia repair using pre-operative Botulinum toxin A (BTA) infiltration of the lateral oblique abdominal muscles as well as a further eight patients with diastasis rectus abdominis who were examined to exclude ventral hernia.
    UNASSIGNED: The use of a functional CT protocol which supplements resting images with additional \"crunching\" images (acquired with the abdominal wall muscles all strongly contracted) can significantly improve the demonstration of ventral hernia defects. Crunching acquisitions can also help differentiate true hernias from dysfunctional bulges, identify muscle denervation or atrophic changes, reveal otherwise occult hernias that may be missed on resting or Valsalva images alone, and assist the pre-operative assessment of BTA effect.
    UNASSIGNED: A more functional approach to pre-operative CT imaging of the abdominal wall can significantly improve the understanding of complex ventral hernia defects and help formulate effective surgical plans that achieve low recurrence rates and good functional outcomes.
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