目的

探讨巨大腹壁切口疝无张力修补术后并发症的发生原因及处理方法。

方法

回顾性分析2021 年9 月至2024 年9 月，在福建医科大学附属协和医院基本外科89 例经肌后/腹膜前修补的巨大切口疝患者的临床资料，对术后并发症预防和处理方法进行总结。

结果

89 例患者的手术时间125～389 min，平均（147±98）min，87 例（97.8%）获得随访，随访时间1～37 个月，平均（21.5±8.4）个月。术后完全拔除引流管时间7～28 d，平均（13.8±6.3）d。无围手术期死亡病例，11 例（12.6%）出现术后并发症，其中血肿1 例（1.1%）、切口脂肪液化3 例（3.4%）、切口感染2 例（2.3%）、麻痹性肠梗阻1 例（1.1%）、腹壁麻木感2 例（2.3%）、慢性疼痛1 例（1.1%），1例（1.1%）术后1 个月内复发，余病例无明显不适，无血清肿、肠瘘、远期复发、腹腔间室综合征等并发症，无死亡病例。

结论

腹壁巨大切口疝围手术期预防是防止术后并发症发生的关键，术前对疝内容物体积、薄弱区范围准确评估，心肺功能锻炼；术中合理放置引流管、必要时减容；术后积极预防感染、腹带加压包扎、尽早处理血肿等是降低并发症发生率的重要方法。

Objective

To explore the causes and management methods of postoperative complications in tension-free repair of giant abdominal wall incisional hernias.

Methods

A retrospective analysis was conducted on the clinical data of 89 cases of giant incisional hernia with muscle posterior/preperitoneal repair in the Department of General Surgery at Fujian Medical University Affiliated Union Hospital from September 2021 to September 2024.The prevention and management methods of postoperative complications were summarized.

Results

The operation time of 89 patients was 125-389 mins, and the average time was (147±98) mins.87 cases (97.8%) were followed up for 1 to 37 months,with an average of (21.5±8.4) months.The time for complete removal of the drainage tube after surgery was 7-28 days, with an average of (13.8±6.3) days.There were no perioperative deaths, with 11 cases(12.6%) experiencing postoperative complications, including 1 case (1.1%) of hematoma, 3 cases (3.4%) of incision fat liquefaction, 2 cases (2.3%) of incision infection, 1 case (1.1%) of paralytic intestinal obstruction, 2 cases (2.3%) of abdominal wall numbness, 1 case (1.1%) of chronic pain, and 1 case (1.1%)of recurrence within 1 month after surgery.The remaining cases had no significant discomfort, no complications such as seroma, intestinal fistula, long-term recurrence, abdominal compartment syndrome,etc., and no deaths.

Conclusion

Perioperative prevention of giant incisional hernias in the abdominal wall is crucial to prevent postoperative complications.The accurate assessment of the volume of hernia contents and the extent of weak areas before surgery, cardiopulmonary exercise, reasonably place drainage tubes during surgery and reducing volume if necessary, actively prevention of infection after surgery, applying pressure bandage to the abdomen, and treating hematoma as early as possible are important methods to reduce the incidence of complications.