腹壁肿瘤扩大切除一期桥接修复腹壁缺损的回顾性研究

doi:10.3877/cma.j.issn.1674-392X.2023.04.003

目的

探讨分析腹壁肿瘤扩大切除后一期进行桥接修复腹壁缺损的临床结果。

方法

回顾性分析由复旦大学附属华东医院和上海交通大学医学院附属第九人民医院同一团队（2021年作者团队工作单位由第九人民医院变更至华东医院），于2016年1月至2022年12月收治，接受腹壁肿瘤扩大切除一期桥接修复的69例患者资料。依据手术方法分为两组。其中45例采用合成不可吸收材料加生物材料双层桥接修复，24例采用生物补片单层桥接修复。主要观察指标为术后腹壁疝发生及腹壁膨出率等，次要观察指标为术后住院天数、引流天数及7 d总引流量和切口相关并发症。

结果

两组患者均顺利完成手术，无术中死亡病例。双层修复组中主要为Ⅰ~Ⅱ级缺损，单层修复组中Ⅲ~Ⅳ级缺损占比较多。双层修复组腹壁疝发生及腹壁膨出率为15.6%，切口相关并发症发生率为17.8%，显著优于单层修复组（83.3%和58.3%）。

结论

腹壁肿瘤扩大切除后桥接修复腹壁缺损中使用双层补片桥接修复可有效降低术后腹壁疝发生及腹壁膨出和切口相关并发症的发生率。但对于感染及污染等情况，仍需要选用生物补片进行桥接修复。

关键词: 腹壁肿瘤, 回顾性研究, 腹壁修复重建, 桥接修复

Objective

To analyze the clinical results of one-stage bridge repair of abdominal wall defect after extended resection of abdominal wall tumor.

Methods

This study retrospectively analyzed the clinical data of 69 patients who underwent extended resection of abdominal wall tumors and one-stage bridging repair by the same team in Huadong Hospital Affiliated to Fudan University and Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University from January 2016 to December 2022. According to the surgical method, they were divided into two groups. Among them, 45 cases were repaired with synthetic non-absorbable materials and biological materials double-layer bridging repair, and 24 cases were repaired with biological materials single-layer bridging repair. The main outcome measures were the incidence of postoperative hernia and abdominal wall bulge rate, etc. The secondary outcome measures were the postoperative hospital stay, drainage days, drainage volume at 7 days and incision related complications.

Results

The operation was successfully completed in both groups, and there was no intraoperative death. There were mainly I-II grade defects in the double-layer repair group, and III-IV grade defects in the single-layer repair group. In the double-layer repair group, the incidence of hernia/abdominal wall bulge was 15.6%, and the incidence of incision related complications was 17.8%, which were significantly better than in the single-layer repair group(83.3% and 58.3%).

Conclusion

The use of double-layer mesh in bridging repair of abdominal wall defect after extended resection of abdominal wall tumor can effectively reduce the incidence of postoperative hernia/abdominal wall bulge and incision-related complications. However, for infection and contamination, biological mesh is still needed for bridging repair.

Key words: Abdominal wall tumor, Retrospective study, Abdominal wall reconstruction, Bridging repair

图1 腹壁肿瘤扩大切除一期桥接修复腹壁缺损注：1A双层修复组评估腹壁肿瘤切除范围腹壁缺损的分区、分级。1B双层修复组使用合成不可吸收补片桥接修复。1C双层修复组使用生物补片覆盖合成不可吸收补片桥接修复。1D单层修复组评估腹壁肿瘤切除范围腹壁缺损的分区、分级，如果患者行皮瓣移植，体表标注需要使用的皮瓣血供，术中注意保护。1E单层修复组使用生物补片桥接修复。1F部分患者使用游离皮瓣覆盖生物补片。

表1 两组患者一般资料比较

组别	例数	年龄(岁,±s)	性别[例(%)]		合并内科疾病[例(%)]
组别	例数	年龄(岁,±s)	男性	女性	合并内科疾病[例(%)]
双层修复组	45	38.6±11.6	11(24.44)	34(75.56)	5(11.11)
单层修复组	24	51.4±14.8	8(33.33)	16(66.67)	10(41.67)
t/χ²		3.972	0.620^&		8.590^&
P		<0.001	0.431		0.003

表1 两组患者一般资料比较

组别	例数	年龄(岁,±s)	性别[例(%)]		合并内科疾病[例(%)]
组别	例数	年龄(岁,±s)	男性	女性	合并内科疾病[例(%)]
双层修复组	45	38.6±11.6	11(24.44)	34(75.56)	5(11.11)
单层修复组	24	51.4±14.8	8(33.33)	16(66.67)	10(41.67)
t/χ²		3.972	0.620^&		8.590^&
P		<0.001	0.431		0.003

表2 两组患者腹壁缺损情况比较

组别	例数	肿瘤大小(cm²,±s)	缺损类型[例(%)]			缺损面积(cm²,±s)	缺损分区[例(%)]
组别	例数	肿瘤大小(cm²,±s)	Ⅰ型	Ⅱ型	Ⅲ型	缺损面积(cm²,±s)	M区	U(L)区	M+U(L)区
双层修复组	45	72.3± 62.0	0	36(80.00)	9(20.00)	244.2±183.6	28(62.22)	3( 6.67)	14(31.11)
单层修复组	24	138.5±187.2	0	11(45.83)	13(54.17)	234.7±158.1	11(45.83)	4(16.67)	9(37.5)
χ²/t		1.682	-	8.413^&	8.413^&	0.214	1.711^&	-	0.288^&
P		0.105	-	0.004	0.004	0.831	0.191	0.227*	0.592
组别	例数	缺损分级[例(%)]				ASA分级[例(%)]
组别	例数	Ⅰ级	Ⅱ级	Ⅲ级	Ⅳ级	Ⅰ级	Ⅱ级	Ⅲ级	Ⅳ级
双层修复组	45	35(77.78)	6(13.33)	4( 8.89)	0	29(64.44)	14(31.11)	2( 4.44)	0
单层修复组	24	6(25.00)	5(20.83)	7(29.17)	6(25.00)	7(29.17)	10(41.67)	5(20.83)	2(8.33)
χ²/t		18.081^&	0.657^&	3.409^#	-	7.807^&	0.769^&	-	-
P		<0.001	0.642	0.065	0.001*	0.005	0.381	0.045*	0.118*

表2 两组患者腹壁缺损情况比较

组别	例数	肿瘤大小(cm²,±s)	缺损类型[例(%)]			缺损面积(cm²,±s)	缺损分区[例(%)]
组别	例数	肿瘤大小(cm²,±s)	Ⅰ型	Ⅱ型	Ⅲ型	缺损面积(cm²,±s)	M区	U(L)区	M+U(L)区
双层修复组	45	72.3± 62.0	0	36(80.00)	9(20.00)	244.2±183.6	28(62.22)	3( 6.67)	14(31.11)
单层修复组	24	138.5±187.2	0	11(45.83)	13(54.17)	234.7±158.1	11(45.83)	4(16.67)	9(37.5)
χ²/t		1.682	-	8.413^&	8.413^&	0.214	1.711^&	-	0.288^&
P		0.105	-	0.004	0.004	0.831	0.191	0.227*	0.592
组别	例数	缺损分级[例(%)]				ASA分级[例(%)]
组别	例数	Ⅰ级	Ⅱ级	Ⅲ级	Ⅳ级	Ⅰ级	Ⅱ级	Ⅲ级	Ⅳ级
双层修复组	45	35(77.78)	6(13.33)	4( 8.89)	0	29(64.44)	14(31.11)	2( 4.44)	0
单层修复组	24	6(25.00)	5(20.83)	7(29.17)	6(25.00)	7(29.17)	10(41.67)	5(20.83)	2(8.33)
χ²/t		18.081^&	0.657^&	3.409^#	-	7.807^&	0.769^&	-	-
P		<0.001	0.642	0.065	0.001*	0.005	0.381	0.045*	0.118*

表3 两组患者术后观察数据比较

组别	例数	腹壁疝发生/腹壁膨出[例(%)]	切口相关并发症[例(%)]	住院时间(d,±s)	引流管放置时间(d,±s)	7 d总引流量(ml,±s)
双层修复组	45	7(15.6)	8(17.8)	21.2±8.9	13.1±5.6	925.9±421.0
单层修复组	24	20(83.3)	14(58.3)	31.5±11.6	18.9±7.5	1222.3±721.4
χ²/t		22.817^&	11.854^&	4.106	3.644	1.852
P		<0.001	0.001	<0.001	0.001	0.073

表3 两组患者术后观察数据比较

组别	例数	腹壁疝发生/腹壁膨出[例(%)]	切口相关并发症[例(%)]	住院时间(d,±s)	引流管放置时间(d,±s)	7 d总引流量(ml,±s)
双层修复组	45	7(15.6)	8(17.8)	21.2±8.9	13.1±5.6	925.9±421.0
单层修复组	24	20(83.3)	14(58.3)	31.5±11.6	18.9±7.5	1222.3±721.4
χ²/t		22.817^&	11.854^&	4.106	3.644	1.852
P		<0.001	0.001	<0.001	0.001	0.073

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A retrospective study of extended resection of abdominal wall tumor and one-stage bridge repair of abdominal wall defect

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A retrospective study of extended resection of abdominal wall tumor and one-stage bridge repair of abdominal wall defect