探索桥接技术治疗复杂腹壁缺损的可行性及效果。

回顾性收集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外科团队于2016年1月至2024年12月收治的73例行桥接修复术的复杂腹壁缺损患者的临床资料，采用回顾性病例对照研究，依术式不同分为3组，分别为单层桥接组（单层补片桥接修复术，23例）、双层桥接组（双层补片桥接修复术，21例）及BOSS桥接组（生物材料-带蒂大网膜瓣-合成材料"三明治"（BOSS）桥接修复术，29例）。分析3组患者的术后引流时间、术后7 d平均引流量、住院时间以及疝复发/腹壁膨出率、切口并发症发生率。

所有患者符合桥接修复术指征，均顺利完成手术。单层桥接组、双层桥接组及BOSS桥接组患者平均腹壁缺损分别为（16.6±6.0）cm×（13.3±4.3）cm、（13.8±3.8）cm×（10.9±3.3）cm和（20.9±7.7）cm×（13.6±5.4）cm；引流管平均放置时间分别为（18.7±8.2）d、（14.5±6.1）d及（15.6±6.4）d，3组比较差异无统计学意义（P=0.111）；术后7 d平均引流量分别为（169.0±105.7）ml、（108.4±45.4）ml及（164.8±76.5）ml，差异有统计学意义（P=0.023）；平均住院时间分别为（26.2±19.7）d、（15.1±10.2）d及（21.2±8.9）d，差异有统计学意义（P=0.010）。术后平均随访（54.0±23.6）个月，单层桥接组、双层桥接组及BOSS桥接组患者疝复发/腹壁膨出率分别为87.0%、23.8%及6.9%，差异有统计学意义（χ²=37.427，P<0.001）；切口并发症发生率分别为43.5%、19.0%及17.2%，差异有统计学意义（χ²=4.282，P=0.028）。

BOSS桥接修复术可显著降低术后复发率及切口并发症发生率，该技术为复杂腹壁缺损的桥接修复提供了新的选择。

To explore the feasibility and effectiveness of bridging technique in repairing complex abdominal wall defect.

The clinical data of 73 patients with complex abdominal wall defect who underwent bridging repair surgery were retrospectively collected. These patients were admitted by the same surgical team from Huadong Hospital Affiliated to Fudan University and the Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine between January 2016 and December 2024. A retrospective case-control study was conducted. According to the different surgical procedures, they were divided into three groups: the single-layer bridging group (single mesh bridging repair, n=23), double-layer bridging group (double-mesh bridging repair, n=21) and BOSS bridging group [biological-omentum-synthetic sandwich (BOSS) bridging repair, n=29]. The data of postoperative drainage days, average drainage volume 7 days after surgery, postoperative hospital stay, postoperative abdominal wall hernia recurrence/bulging rate and the incidence of incision complications in three groups of patients were analyzed.

All patients met the surgical indications and completed the operation successfully. The average length×width of abdominal wall defects for patients in the single-layer bridging group, double-layer bridging group and BOSS bridging group were (16.6±6.0) cm× (13.3±4.3) cm, (13.8±3.8) cm×(10.9±3.3) cm and (20.9±7.7) cm×(13.6±5.4) cm. The mean time of drainage tube was (18.7±8.2) days, (14.5±6.1) days and (15.6±6.4) days, respectively, and the difference was not statistically significant (P=0.111). The average drainage volume 7 days after surgery was (169.0±105.7) ml, (108.4±45.4) ml and (164.8±76.5) ml, respectively, and the difference was statistically significant (P=0.023). The average hospital stay was (26.2±19.7) days, (15.1±10.2) days, and (21.2±8.9) days, respectively, and the difference was statistically significant (P=0.010). The mean follow-up period was (54.0±23.6) months. The recurrence/bulging rate of abdominal wall hernia was 87.0%, 23.8% and 6.9% in the single-layer bridging group, double-layer bridging group and BOSS bridging group, respectively, with statistically significant differences (χ²=37.427, P<0.001). The incidence of incision complications was 43.5%, 19.0% and 17.2%, respectively, with statistically significant differences (χ²=4.282, P=0.028).

BOSS bridging technique can significantly reduce the postoperative recurrence rate and the incidence of incisional complications. This technique provides a new solution for bridging repair of complex abdominal wall defects.