【摘要】 目的 探讨采用人脱细胞真皮基质(HADM)腹直肌前鞘及腹膜双层桥式缝合法重建腹腔开放术后巨大复杂性腹壁缺损的临床价值.方法 采用回顾性横断面研究方法.收集2013年1月至2014年1月南京大学医学院南京军区南京总医院收治的6例严重外伤患者的临床资料.患者行腹腔开放术后,采用组织结构分离术充分游离腹壁筋膜.采用HADM腹直肌前鞘及腹膜双层桥式缝合法重建缺损腹壁.观察指标:(1)术中及术后情况:手术时间、术中出血量、术后引流管拔除时间、术后并发症、术后住院时间、住院费用.(2)随访情况:术后2年腹壁疝复发情况.采用门诊和电话方式进行随访,了解患者术后腹壁疝复发情况.随访时间截至2016年4月.正态分布的计量资料采用x±s表示.结果 (1)术中及术后情况:6例患者均顺利完成手术.手术时间为(77±9) min,术中出血量为(225±57) mL,术后引流管拔除时间为(8±3)d.术后2例患者出现明显血清肿,予保守治疗后治愈.l例患者因行腹壁缺损修补术同时行肠吻合术,术后发生吻合口瘘,予持续冲洗引流,采用生物蛋白胶成功封堵.6例患者住院期间无腹部膨隆发生.6例患者术后住院时间为(10±3)d,住院费用为(12±7)万元.(2)随访情况:6例患者均获得术后随访,随访时间为14～28个月,中位随访时间为23个月.2例患者术后2年腹膜层HADM松弛膨出,无腹直肌前鞘层HADM膨出.无腹壁疝复发患者,无慢性疼痛、感觉异常、局部红肿等不良反应.结论 采用HADM腹直肌前鞘及腹膜双层桥式缝合法重建腹腔开放术后巨大复杂性腹壁缺损安全可行,近期疗效较好.

关键词 复杂性腹壁缺损；腹腔开放术；人脱细胞真皮基质

Clinical value of human acellular dermal matrix in reconstruction of giant complex abdominal wall defects after open abdomen

Mao Qi；Kong Wencheng；Chen Yong；Wang Jian；Yao Danhua；Li Yousheng；Li Jieshou

Research Institute of General Surgery of PM. Nanjing General Hospital of Nanjing Military Command. School of Medicine,Nanjing University,Nanjing 210002，China

【Abstract】: Objective To explore the clinical value of human acellular dermal matrix (HADM) in giant complex abdominal wall reconstruction (GCAWR) after open abdomen.Methods The retrospective crosssectional study was conducted.The clinical data of 6 patients with severe trauma who were admitted to the Nanjing General Hospital of Nanjing Military Command of Nanjing University School of Medicine between January 2013 and January 2014 were collected.After open abdomen,fascia of the abdominal wall was fully freed using the component separation,and abdominal wall defects were reconstructed using HADM in the rectus abdominis anterior sheath and peritoneal layers bridge-type suture.Observation indicators:(1) intra-and post-operative situations:operation time,volume of intraoperative blood loss,removal time of postoperative drainage-tube,postoperative complications,duration of hospital stay and hospital expenses;(2) follow-up situations:recurrence of abdominal wall hernia at postoperative year 2.Follow-up using outpatient examination and telephone interview was performed to detect the recurrence of abdominal wall hernia up to April 2016.Measurement data with normal distribution were represented as ±s.Results (1) Intra-and post-operative situations:6 patients underwent successful surgery.Operation time,volume of intraoperative blood loss and removal time of postoperative drainage-tube were respectively (77±9)minutes,(225±57)mL and (8±3)days.Two patients with postoperative seroma were cured by conservative treatment.One patient with postoperative anastomotic leakage received continuously irrigation and drainage,and leakage was stopped using the biomedical fibrin glue.There was no abdominal bulge of the 6 patients in hospital.Duration of hospital stay and hospital expenses were respectively (10±3) days and (12±7)×10⁴ yuan.(2) Follow-up situations:6 patients were followed up for 14-28 months,with a median time of 23 months.Two patients had relaxation and bulge of HADM in peritoneal layer at postoperative 2 years,without bulge of HADM in the rectus abdominis anterior sheath layer.There were no occurrence of abdominal wall hernia,chronic pain,paraesthesia,swelling in the local area and other adverse reaction.Conclusion Using of HADM in the rectus abdominis anterior sheath and peritoneal layers bridge-type suture is safe and feasible for GCAWR,with good short-term outcomes. 

[Keywords] Complex abdominal wall defect；Open abdomen；Human acellular dermal matrix