探讨主动减容联合Onlay术在治疗巨大腹壁疝及防治其相关并发症中的临床应用。

回顾性分析2015年1月至2016年6月，新疆维吾尔自治区人民医院18例巨大腹壁疝患者的临床资料，术前均通过MSCT测疝囊容积、腹腔容积、疝环大小，根据容积比选择主动减容联合Onlay术，观察其手术时间、切除肠管长度、出血量、膀胱内压力、术后胃肠功能恢复时间、下床活动时间、引流管拔出时间、住院时间、并发症发生率及复发情况率。

平均手术时间为（2.1±0.8）h，切除肠管长度为（49.4±15.0）cm，术中出血量为（82±30.1）ml。膀胱内测压：IAHⅠ级3例（3/18），出现IAHⅡ级1例（1/18），无IAH Ⅲ、Ⅳ级发生；围手术期无腹腔间室综合征发生，无死亡病例；患者术后均未出现心、肝、肾及呼吸功能异常；有2例出现切口积液，1例术后出现切口浅表感染，经对症处理后好转，无迟发感染；随访8～24个月，平均随访时间（14.0±2.1）个月，有1例患者出现腹壁切口疝复发，暂未行二次手术。

主动减容联合Onlay术治疗巨大腹壁疝可有效防治术后由于腹腔内高压所导致的相关并发症发生，安全可行。

To explore the clinical application of initiative content reduction with Onlay surgery for the treatment of large incisional hernia and prevention its complications.

A retrospective study was conducted on 18 cases of large incisional hernia in Xinjiang Uygur Autonomous Region People's Hospital from January 2015 to June 2016, and all patients underwent preoperative MSCT to measure the volume of the hernia sac and the volume of abdominal cavity, the diameter of the hernia size. The initiative content reduction with Onlay surgery was performed according to the volume ratio. The operation time, blood loss, resection length, intravesical pressure, normal activity time, duration in hospital time, complications and recurrence rate were observed.

The mean operation time was (2.1±0.8) hours; the resection length was (49.4±15) cm; blood loss was (82±30.1) ml. The intravesical pressure showed that there were 3 cases (3/18) of IAH Grade Ⅰ, 1 case (1/18) of IAH Grade Ⅱ, none of ACS during perioperative period (IAH Ⅲ, IAH Ⅳ), no deaths. There were 2 cases of incision effusion and 1 case of incisional infection, improved after symptomatic treatment, no delayed infection. After 8 to 24 months of follow-up, one patient had recurrence without re-operation.

Initiative content reduction combined with Onlay surgery is safe and feasible to prevent the complications associated with intra-abdominal pressure of large incisional hernia repair, worthy spreading and need to further study.