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中华疝和腹壁外科杂志(电子版) ›› 2022, Vol. 16 ›› Issue (05) : 497 -501. doi: 10.3877/cma.j.issn.1674-392X.2022.05.002

综述

腹直肌分离的外科治疗
张俊松1, 刘玉海1, 吴立胜2,()   
  1. 1. 230601 安徽医科大学第三附属医院 合肥市滨湖医院胃肠外科
    2. 230001 合肥,中国科学技术大学附属第一医院疝与减重代谢外科
  • 收稿日期:2022-02-18 出版日期:2022-10-18
  • 通信作者: 吴立胜

Surgical treatment of the diastasis recti abdominis

Junsong Zhang1, Yuhai Liu1, Lisheng Wu2,()   

  1. 1. The Third Affiliated Hospital of Anhui Medical University, Department of Gastrointestinal Surgery of Hefei Binhu Hospital, He Fei 230601, China
    2. Department of Hernia and Bariatric Metabolic Surgery, First Affiliated Hospital of University of Science and Technology of China, Hefei 230001, China
  • Received:2022-02-18 Published:2022-10-18
  • Corresponding author: Lisheng Wu
引用本文:

张俊松, 刘玉海, 吴立胜. 腹直肌分离的外科治疗[J]. 中华疝和腹壁外科杂志(电子版), 2022, 16(05): 497-501.

Junsong Zhang, Yuhai Liu, Lisheng Wu. Surgical treatment of the diastasis recti abdominis[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2022, 16(05): 497-501.

腹直肌分离(DRA)是产后妇女常见疾病。由于国内对DRA认知不足,且其本身治疗方案争议颇大,截至目前尚无指南规范其诊疗。在国外,DRA的外科治疗已受到外科医师和患者的逐步重视,但国内仅有少数大的腹壁外科中心开始进行研究。本文根据国内外DRA研究现状,对DRA外科治疗的手术方式、补片应用与否、开放或腔镜的选择等进行综述,并在此基础上提出手术指征及今后发展方向。

Diastasis recti abdominis (DRA) is a common disease in postpartum women. Currently, there is no guidelines to standardize its diagnosis and treatment due to the lack of cognition in China and considerable controversy treatment plan. Surgical treatment of DRA has drawn more and more attention by surgeons and patients abroad, while similar studies has only begun in a few large abdominal surgical centers in China. This review demonstrated the surgical methods, mesh application and endoscopy or open for the surgical treatment of DRA according to its research status at home and abroad, and proposed the surgical indications and future development on that basis.

表1 尸体研究中不同部位白线正常宽度最大值(mm)
表2 肌腱膜缺陷的定量分类
[1]
Beer GM, Schuster A, Seifert B, et al. The normal width of the linea alba in unlliparous women[J]. Clin Anat, 2009, 22(6): 706-711.
[2]
Sperstad JB, Tennfjord MK, Hilde G, et al. Diastasis recti abdominis during pregnancy and 12 months after childbirth: prevalence, risk factors and report of lumbopelvic pain[J]. Br J Sports Med, 2016, 50(17): 1092-1096.
[3]
Köckerling F, Botsinis MD, Rohde C, et al. Endoscopic-assisted linea alba reconstruction plus mesh augmentation for treatment of umbilical and/or epigastric hernias and rectus abdominis diastasis-early results[J]. Front Surg, 2016, 3(27): 1-6.
[4]
Köhler G, Luketina RR, Emmanuel K, et al. Sutered repair of primary small umbilical and epigastric hernias: concomitant rectus diastasis is a significant risk factor for recurrence[J]. World J Surg, 2015, 39(1): 121-126.
[5]
Lee DG, Lee LJ, McLauqhlin L. Stability, continence and breathing: the role of fascia following pregnancy and delivery[J]. J Bodyw Mov Ther, 2008, 12(4): 333-348.
[6]
Deenika R, Benjamin, Helena C, et al. Relationship between diastasis of the rectus abdominis muscle(DRAM) and musculoskeletal dysfunctions, pain, and quality of life: a systematic review[J]. Physiotherapy, 2019, 105(1): 24-34.
[7]
Nahas FX. An aesthetic classification of the abdomen based on the myoaponeurotic layer[J]. Plast Reconstr Surg, 2001, 108(6): 1787-1795; discussion 1796-1797.
[8]
Rath AM, Attali P, Dumas JL, et al. The abdominal linea alba: an anatomo-radiologic and biomechanical study[J]. Surg Radiol Anat, 1996, 18(4): 281-188.
[9]
Cheesborough JE, Dumanian GA. Simultaneous prosthetic mesh abdominal wall reconstruction with abdominoplasty for ventral hernia and severe rectus diastasis repairs[J]. Plast Reconstr Surg, 2015, 135(1): 268-276.
[10]
Pechter EA. Instant identification of redundant tissue in abdominoplasty with a marking grid[J]. Aesthet Surg J, 2010, 30(4): 571-578.
[11]
Van Uchelen JH, Kon M, Werker PM. The long-term durability of plication of the anterior rectus sheath assessed by ultrasonography[J]. Plast Reconstr Surg, 2001, 107(6): 1578-1584.
[12]
Gama LJM, Barbosa MVJ, Czapkowski A, et al. Single-Layer plication for repair of diastasis recti: the most rapid and efficient technique[J]. Aesthet Surg, 2017, 37(6): 698-705.
[13]
Nahas FX, Augusto SM, Ghelfond C. Nylon versus polydioxanone in the correction of rectus diastasis[J]. Plast Reconstr Surg, 2001, 107(3): 700-706.
[14]
Tadiparthi S, Shokrollahi K, Doyle GS, et al. Rectus sheath plication in abdominoplasty: assessment of its longevity and a review of the literature[J]. J Plast Reconstr Aesthet Surg, 2012, 65(3): 328-332.
[15]
Chalya PL, Massinde AN, Kihunrwa A, et al. Abdominal fascia closure following elective midline laparotomy: a surgical experience at a tertiary care hospital in Tanzania[J]. BMC Res Notes, 2015, 8: 281.
[16]
Ishida LH, Gemperli R, Longo MV, et al. Analysis of the strength of the abdominal fascia in different sutures used in abdominoplasties[J]. Aesthetic Plast Surg, 2011, 35(4): 435-438.
[17]
Elkhatib H, Buddhavarapu SR, Henna H, et al. Abdominal musculoaponeuretic system: magnetic resonance imaging evaluation before and after vertical plication of rectus muscle diastasis in conjunction with lipoabdominoplasty[J]. Plast Reconstr Surg, 2011, 128(6): 733e-740e.
[18]
Mestak O, Kullac R, Mestak J, et al. Evaluation of the long-term stability of sheath plication using absorbable sutures in 51 patients with diastasis of the recti muscles: an ultrasonographic study[J]. Plast Reconstr Surg, 2012, 130(5): 714e-719e.
[19]
Ferreira LM, Castilho HT, Hochberg J, et al. Triangular mattress suture in abdominal diastasis to prevent epigastric bulging[J]. Ann Plast Surg, 2001, 46(2): 130-134.
[20]
Veríssimo P, Nahas FX, Barbosa MV, et al. Is it possible to repair diastasis recti and shorten the aponeurosis at the same time?[J]. Aesthetic Plast Surg, 2014, 38(2): 379-386.
[21]
Palanivelu C, Rangarajan M, Jategaonkar PA, et al. Laparoscopic repair of diatasis recti using the 'Venetian blinds’ technique of plication with prosthetic reinforcement: a retrospective study[J]. Hernia, 2009, 13(3): 187-192.
[22]
Angio LG, Piazzese E, Pacilè V, et al. The surgical treatment of the diastasis recti abdominis: an original technique of prosthesis repair of the abdominal wall[J]. G Chir, 2007, 28(5): 187-198.
[23]
Matei OA, Runkel N. A novel technique of midline mesh repair for umbilical hernia associated with diastasis recti[J]. Surg Technol, 2014, 24: 183-187.
[24]
Carrara A, Lauro E, Fabris, et al. Endo-laparoscopic reconstruction of the abdominal wall midline with linear stapler, the THT technique. Early results of the first case series[J]. Ann Med Surg(Lond), 2018, 38: 1-7.
[25]
Siddiky AH, Kapadia CR. Laparoscopic plication of the linea alba as a repair for diastasis recti- a mesh free approch[J]. J Surg Case Rep, 2010(5): 3.
[26]
Chang CJ. Assessment of videoendoscopy-assisted abdominoplasty for diastasis recti patients[J]. Biomed J, 2013, 36(5): 252-256.
[27]
Emanuelsson P, Gunnarsson U, Dahlstrand U, et al. Operation of abdominal rectus diastasis(ARD) reduces pain and improves abdominal wall muscle strength: A randomized, prospective trial comparing retromuscular mesh repair to double-row, self-retaining sutures[J]. Surgery, 2016, 160(5): 1367-1375.
[28]
Köckerling F, Botsinis MD, Rohde C, et al. Endoscopic-assisted linea alba reconstruction: New technique for treatment of symptomatic umbilical, trocar, and/or epigastric hernias with concomitant rectus abdominis diastasis[J]. Eur Surg, 2017, 49(2): 71-75.
[29]
Barchi LC, Franciss MY, Ziberstein B. Subcutaneous videosurgery for abdominal wall defects: a prospective observational study[J]. J Laparoendosc Adv Surg Tech A, 2019, 29(4): 523-530.
[30]
Claus CMP, Malcher F, Cavazzola LT, et al. Subcutaneous onlay laparoscopic approach(SCOLA) for ventral hernia and rectus abdominis diastasis repair: technical description and initial results[J]. Arg Bras Cir Dig, 2018, 31(4): e1399.
[31]
Hansson BM, Slater NJ, van der Velden AS, et al. Surgical techniques for parastomal hernia repair: a systematic review of the literature[J]. Ann Surg, 2012, 255(4): 685-695.
[32]
唐建雄. 腹壁巨大切口疝手术方法的选择[J]. 腹部外科, 2009, 22(3): 133-134.
[33]
Privett BJ, Ghusn M. Proposed technique for open repair of a small umbilical and rectus divarication with self-gripping mesh[J]. Hernia, 2016, 20(4): 527-530.
[34]
Wiessner R, Vorwerk T, Tolla-Jensen C, et al. Continuous laparoscopic closure of the linea alba with barbed sutures combined with laparoscopic implantation(IPOM plus repair) as a new technique for treatment of abdominal hernias[J]. Front Surg, 2017, 4: 62.
[35]
Brauman D. Diastasis recti: clinical anatomy[J]. Plast Reconstr Surg, 2008, 122(5): 1564-1569.
[36]
Klein F, Ospina C, Rudolph B, et al. Formation of a chronic pain syndrome due to mesh shrinkage after laparoscopic intraperitoneal onlay mesh(IPOM)[J]. Surg Laparosc Endosc Percutan Tech, 2012, 22(5): e288-290.
[37]
Mommers EHH, Ponten JEH, Al Omar AK, et al. The general surgeon’s perspective of rectus diastasis. A systematic review of treatment options[J]. Surg Endosc, 2017, 31(12): 4934-4949.
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