探讨CT扫描在腹壁修补术后补片感染中的诊断应用价值。

选取2020年1月至2021年6月于南京医科大学第一附属医院行各类疝补片修补术后疑腹壁感染的患者23例。腹股沟疝网塞平片术后12例，Lichtenstein术后2例，腹腔镜经腹腹膜前疝修补术（TAPP）术后1例，腹腔镜完全腹膜外疝修补术（TEP）术后3例，腹壁切口疝修补Onlay术后2例，Underlay术后1例，腹腔内补片植入修补法（IPOM）术后2例。术前或保守治疗期间全部给予腹部CT平扫检查，对于慢性感染有伤口窦道者，检查前30 min窦道口灌注造影剂。行感染补片取出术时，有窦道者手术开始前给予亚甲蓝窦道灌注。术中诊断补片感染的标准为切开补片感染灶时见脓液流出、感染灶内补片被亚甲蓝蓝染或感染灶周围解剖出未与组织融合呈游离状的补片。

16例慢性感染有腹壁窦道者中，1例深部未显影仅皮下段显影，余15例窦道造影均显影至深部补片所在位置。16例亚甲蓝染色有13例窦道和深部补片被染色。5例无窦道的慢性感染患者CT平扫均见腹壁深部感染灶显像，其中1例肌后脓肿形成者脓腔中可见聚丙烯网片显影。2例急性感染病例CT动态检查见证了感染补片被治愈的影像学改变，其中1例腹股沟双侧感染病例，一侧补片感染被诊断为保守治疗无效，转感染补片去除术时网片仍然浸泡在脓液中。

CT平扫对于腹壁感染具有较高的诊断价值，结合补片局部植入信息，是术前诊断深部补片感染的有效方法，可以指导治疗方案的选择；有条件行窦道造影者，CT检查还可以提供更多与补片感染相关的诊断。

Purpose To investigate the adoption of multidetector computed tomography (CT) for the diagnosis of the abdominal wall infection involving mesh post various ventral hernia repairs with mesh.

The total 23 cases of suspected abdominal wall infection after various ventral hernia repairs with mesh implantation were retrospectively studied, including 12 cases of inguinal hernioplasty with Mesh-plug (MP), 2 cases of Lichtenstein, 1 case of TAPP and 3 cases of TEP for inguinal hernia; and 2 cases of Onlay, 1 case of Underlay and 2 cases of IPOM for incisional hernia. For all cases, abdominal CT scan was employed prior to operation. For chronic infections with sinus in the infection site, contrast agent was injected into the sinus 30 minutes before CT scan. For the patients to undergo operation for the removal of the infected meshes, methylene blue was injected into the sinus at the beginning of operation. The diagnosis of mesh infection was established when the pus collection detected, mesh stained with methylene blue and/or mesh not integrated into the surrounding tissue during the operation exploring the infected site.

For 16 cases of chronic abdominal wall infection with sinus radiography, only 1 case with contrast agent just developing limited to the subcutaneous layer instead of permeating into the deeper area while the rest 15 cases with contrast agent developing deep into where the mesh infection occurred. For the above-mentioned 16 cases with methylene blue injection, both sinus and infected mesh were stained in 13 cases. For 5 cases of chronic infection without sinus, deep infection sites were all identified on CT, of which one case of post muscular abscess formation with polypropylene mesh identified in the abscess cavity. For 2 cases of acute infection after inguinal hernia repair, CT scan showed the image development of infected areas involving mesh in the process of treatment; with one case of infection post bilateral inguinal hernia MP repair, infected mesh was found to be surrounded by pus when converted to operation after non-operative management failed on one side.

CT scan (with sinus radiography if permitted) is an effective method for the diagnosis of abdominal wall infection involving mesh post ventral hernia repair with mesh and so provide the evidence for choice of treatment as concerns about mesh removal or not.