探讨人工防粘连复合补片联合组织结构分离技术修补腹壁肿瘤切除后腹壁巨大缺损的方法及疗效。

回顾性分析2020年2月至2022年7月，山西省人民医院普外科胃肠胰及疝与腹壁外科病区收治的12例腹壁肿瘤或腹壁巨大肿瘤切除术后腹壁大面积缺损进行治疗修复患者的临床资料。12例均符合腹壁缺损分型Ⅲ型标准。其中5例缺损中心在M1~M3区，1例在M4区，3例在U区，3例在L区。M1~M3区病例采用复合补片固定联合腹横肌松解（TAR）进行腹壁完整修复，M4、L区补片下缘固定于Cooper韧带，U区补片上缘固定在肋间隙，对侧方插入肌后间隙，分离皮下组织后给予一期缝合。补片超过缺损缘至少5 cm。对于巨大的腹壁肿瘤切除后无法关闭的行补片与腹壁桥接。修补完成后，补片前方常规低位放置负压引流管。术后引流管持续负压吸引，腹壁给予腹带加压包扎。所有患者进行随访。

12例患者腹壁肿瘤均达到R0切除。术后24 h引流液量60~210 ml，平均130 ml。引流管拔除指征为连续3 d 24 h引流量少于10 ml，拔管时间在术后12~35 d，平均21.3 d。拔管后发生皮下积液、血清肿3例，给予穿刺抽吸后局部置管引流、加压包扎等措施后治愈。发生术后腹壁疼痛2例，给予止痛对症治疗后疼痛症状消失。发生肺部感染及切口感染各1例，给予抗感染、换药、氧化雾化、拍背咳痰治疗后治愈。发生不全肠梗阻1例，给予温肥皂水灌肠、下地床旁活动后治愈。术后无发生腹腔间隔室综合征病例。出院后所有患者均获随访，随访时间为4个月~2年。随访期间局部肿瘤复发1例，无腹壁切口疝及粘连性肠梗阻发生病例。

应用复合补片结合组织结构分离技术，利用肌后腹膜前间隙将补片边缘区可靠固定来修补肿瘤切除后的腹壁大面积缺损，是一种有效、可靠、安全的手术方式，能有效预防腹壁切口疝、粘连性肠梗阻等并发症。

To investigate the method and efficacy of artificial anti-adhesion composite mesh combined with component separation technique for repairing huge abdominal wall defects after abdominal wall tumor resection.

A retrospective analysis was conducted on the clinical data of 12 patients who underwent treatment and repair of large abdominal wall defects after resection of abdominal wall tumors or giant abdominal wall tumors in the Department of Gastroentero-pancreatic, Hernia and Abdominal Wall Surgery, Shanxi Provincial People's Hospital from February 2020 to July 2022. All the 12 cases met the criteria of type Ⅲ abdominal wall defect classification. The defect centers of 5 cases were located in the M1-M3 area, 1 case in the M4 area, 3 cases in the U area, and 3 cases in the L area. The lower edge of M4 and L area mesh was fixed to Cooper's ligament, the upper edge of U area mesh was fixed to the intercostal space, and the opposite side was inserted into the retromuscular space. After separation of subcutaneous tissue, the primary suture was performed. The mesh exceeded the margin of the defect by at least 5 cm. For huge abdominal wall tumors that could not be closed after resection, mesh was used to bridge the abdominal wall. After the repair was completed, a negative pressure drainage tube was routinely placed at a low position in front of the patch. After operation, the drainage tube was continuously suctioned with negative pressure, and the abdominal wall was bandaged with abdominal band pressure. All patients were followed up.

R0 resection of abdominal wall tumors was achieved in all 12 patients. The amount of drainage fluid for 24 hours after surgery was 60~210 ml, with an average of 130 ml. The indication of drainage tube removal was that the drainage volume was less than 10 ml for 24 hours on 3 consecutive days, and the extubation time was 12-35 days after surgery, with an average of 21.3 days. Subcutaneous effusion and seroma occurred in 3 cases after extubation, which were cured by local catheter drainage and pressure bandaging after puncture and aspiration. Postoperative abdominal wall pain occurred in 2 cases, and the pain symptoms disappeared after symptomatic treatment. One case of pulmonary infection and one case of incision infection were cured after treatment with antibiotics, dressing changes, oxidation atomization, back patting, and sputum. One case of incomplete intestinal obstruction was cured by an enema with warm soapy water and bedside activities. No cases of abdominal compartment syndrome occurred after operation. All patients were followed up from 4 months to 2 years after discharge. During follow-up, 1 patient had local tumor recurrence, and the rest did not have an abdominal incisional hernia or an adhesive ileus.

The application of composite mesh combined with component separation technology, using the retromuscular preperitoneal space to reliably fix the edge area of mesh to repair the large abdominal wall defect after tumor resection, is an effective, reliable and safe surgical method, can effectively prevent the abdominal wall incisional hernia, adhesive intestinal obstruction and other complications.