• 解放軍總醫(yī)院第一附屬醫(yī)院普通外科（北京 100048）;

目的總結腹壁疝補片修補術后感染的外科處理方法及經(jīng)驗。方法回顧性分析我科2007年6月至2010年5月期間16例腹壁疝補片修補術后感染并接受外科處理的患者的臨床資料，其中男10例，女6例; 年齡24～73歲，平均45.2歲。其中腹壁切口疝補片修補術后感染11例，腹壁腫瘤切除術后腹壁缺損補片修補術后感染4例，回腸代膀胱造口旁疝補片修補術后感染并尿瘺1例。患者表現(xiàn)有補片暴露、慢性流膿、腹壁慢性竇道及腸皮瘺，均就診于初次手術的醫(yī)生，經(jīng)局部換藥處理后3～24個月未愈?；颊咴谖铱平邮芰烁涡愿腥揪W(wǎng)片切除及腹壁重建術。結果所有患者均將感染補片取出，5例采用成分分離技術自體組織游離修補，4例同時應用聚丙烯平片加強修補，5例同時行脫細胞基質(zhì)生物補片修補，1例未行修補給予切口創(chuàng)面負壓吸引加局部換藥，1例去除補片后未行加強修補直接縫合關閉切口。術后住院時間9～25 d，平均14 d。術后切口一期愈合13例，其余3例切口經(jīng)局部換藥二期愈合。隨訪6～34個月,平均22個月，無疝復發(fā)。結論腹壁疝或缺損補片修補術后感染的外科處理非常棘手，需根據(jù)患者個體具體情況處理方可取得滿意效果。

引用本文： 劉飛德,李基業(yè),姚勝,王世斌,朱瑛梅,裴利娟,史憲杰. 腹壁疝補片修補術后感染的外科處理. 中國普外基礎與臨床雜志, 2011, 18(12): 1292-1295. doi: 復制

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2. Leber GE, Garb JL, Alexander AI, et al. Longterm complications associated with prosthetic repair of incisional hernias [J]. Arch Surg, 1998, 133(4): 378382.
3. White TJ, Santos MC, Thompson JS. Factors affecting wound complications in repair of ventral hernias [J]. Am Surg, 1998, 64(3): 276280.
4. Junge K, Rosch R, Klinge U, et al. Gentamicin supplementation of polyvinylidenfluoride mesh materials for infection prophylaxis [J]. Biomaterials, 2005, 26(7): 787793.
5. Yerdel MA, Akin EB, Dolalan S, et al. Effect of singledose prophylactic ampicillin and sulbactam on wound infection after tensionfree inguinal hernia repair with polypropylene mesh: the randomized, doubleblind,prospective trial [J]. Ann Surg, 2001, 233(1): 2633.
6. Park A, Birch DW, Lovrics P. Laparoscopic and open incisional hernia repair: a comparison study [J]. Surgery, 1998, 124(4): 816821.
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8. Ramirez OM, Ruas E, Dellon AL. “Components separation” method for closure of abdominalwall defects: an anatomic and clinical study [J]. Plast Reconstr Surg, 1990, 86(3): 519526.
9. Saulis AS, Dumanian GA. Periumbilical rectus abdominis perforator preservation significantly reduces superficial wound complications in “separation of parts” hernia repairs [J]. Plast Reconstr Surg, 2002, 109(7): 22752280.
10. Fabian TC, Croce MA, Pritchard FE, et al. Planned ventral hernia. Staged management for acute abdominal wall defects [J]. Ann Surg, 1994, 219(6): 643650.
11. Dibello JN, Moore JH. Sliding myofascial flap of the rectus abdominus muscles for the closure of recurrent ventral hernias [J]. Plast Reconstr Surg, 1996, 98(3): 464469.
12. Lucas CE, Ledgerwood AM. Autologous closure of giant abdominal wall defects [J]. Am Surg, 1998, 64(7): 607610.
13. Girotto JA, Ko MJ, Redett R, et al. Closure of chronic abdominal wall defects: a longterm evaluation of the components separation method [J]. Ann Plast Surg, 1999, 42(4): 385394.
14. Mathes SJ, Steinwald PM, Foster RD, et al. Complex abdominal wallreconstruction: a comparison of flap and mesh closure [J]. Ann Surg, 2000, 232(4): 586596.
15. Dayton MT, Buchele BA, Shirazi SS, et al. Use of an absorbable mesh to repair contaminated abdominalwall defects [J]. Arch Surg, 1986, 121(8): 954960.
16. Silverman RP, Li EN, Holton LH, et al. Ventral hernia repair using allogenic acellular dermal matrix in a swine model [J]. Hernia, 2004, 8(4): 336342.
17. Sclafani AP, McCormick SA, Cocker R. Biophysical and microscopic analysis of homologous dermal and fascial materials for facial aesthetic and reconstructive uses [J]. Arch Facial Plast Surg, 2002, 4(3): 164171.
18. An G, Walter RJ, Nagy K. Closure of abdominal wall defects using acellular dermal matrix [J]. J Trauma, 2004, 56(6): 12661275.
19. Menon NG, Rodriguez ED, Byrnes CK, et al. Revascularization of human acellular dermis in fullthickness abdominal wall reconstruction in the rabbit model [J]. Ann Plast Surg, 2003, 50(5): 523527.
20. Sclafani AP, Romo T 3rd, Jacono AA, et al. Evaluation of acellular dermal graft (alloderm) sheet for soft tissue augmentation: a 1year followup of clinical observations and histological findings [J]. Arch Facial Plast Surg, 2001, 3(2): 101103.
  1. 1. Luijendijk RW, Hop WC, van den Tol MP, et al. A comparison of suture repair with mesh repair for incisional hernia [J]. N Engl J Med, 2000, 343(6): 392398.
  2. 2. Leber GE, Garb JL, Alexander AI, et al. Longterm complications associated with prosthetic repair of incisional hernias [J]. Arch Surg, 1998, 133(4): 378382.
  3. 3. White TJ, Santos MC, Thompson JS. Factors affecting wound complications in repair of ventral hernias [J]. Am Surg, 1998, 64(3): 276280.
  4. 4. Junge K, Rosch R, Klinge U, et al. Gentamicin supplementation of polyvinylidenfluoride mesh materials for infection prophylaxis [J]. Biomaterials, 2005, 26(7): 787793.
  5. 5. Yerdel MA, Akin EB, Dolalan S, et al. Effect of singledose prophylactic ampicillin and sulbactam on wound infection after tensionfree inguinal hernia repair with polypropylene mesh: the randomized, doubleblind,prospective trial [J]. Ann Surg, 2001, 233(1): 2633.
  6. 6. Park A, Birch DW, Lovrics P. Laparoscopic and open incisional hernia repair: a comparison study [J]. Surgery, 1998, 124(4): 816821.
  7. 7. Ríos A, Rodríguez JM, Munitiz V, et al. Antibiotic prophylaxis in incisional hernia repair using a prosthesis [J]. Hernia, 2001, 5(3): 148152.
  8. 8. Ramirez OM, Ruas E, Dellon AL. “Components separation” method for closure of abdominalwall defects: an anatomic and clinical study [J]. Plast Reconstr Surg, 1990, 86(3): 519526.
  9. 9. Saulis AS, Dumanian GA. Periumbilical rectus abdominis perforator preservation significantly reduces superficial wound complications in “separation of parts” hernia repairs [J]. Plast Reconstr Surg, 2002, 109(7): 22752280.
  10. 10. Fabian TC, Croce MA, Pritchard FE, et al. Planned ventral hernia. Staged management for acute abdominal wall defects [J]. Ann Surg, 1994, 219(6): 643650.
  11. 11. Dibello JN, Moore JH. Sliding myofascial flap of the rectus abdominus muscles for the closure of recurrent ventral hernias [J]. Plast Reconstr Surg, 1996, 98(3): 464469.
  12. 12. Lucas CE, Ledgerwood AM. Autologous closure of giant abdominal wall defects [J]. Am Surg, 1998, 64(7): 607610.
  13. 13. Girotto JA, Ko MJ, Redett R, et al. Closure of chronic abdominal wall defects: a longterm evaluation of the components separation method [J]. Ann Plast Surg, 1999, 42(4): 385394.
  14. 14. Mathes SJ, Steinwald PM, Foster RD, et al. Complex abdominal wallreconstruction: a comparison of flap and mesh closure [J]. Ann Surg, 2000, 232(4): 586596.
  15. 15. Dayton MT, Buchele BA, Shirazi SS, et al. Use of an absorbable mesh to repair contaminated abdominalwall defects [J]. Arch Surg, 1986, 121(8): 954960.
  16. 16. Silverman RP, Li EN, Holton LH, et al. Ventral hernia repair using allogenic acellular dermal matrix in a swine model [J]. Hernia, 2004, 8(4): 336342.
  17. 17. Sclafani AP, McCormick SA, Cocker R. Biophysical and microscopic analysis of homologous dermal and fascial materials for facial aesthetic and reconstructive uses [J]. Arch Facial Plast Surg, 2002, 4(3): 164171.
  18. 18. An G, Walter RJ, Nagy K. Closure of abdominal wall defects using acellular dermal matrix [J]. J Trauma, 2004, 56(6): 12661275.
  19. 19. Menon NG, Rodriguez ED, Byrnes CK, et al. Revascularization of human acellular dermis in fullthickness abdominal wall reconstruction in the rabbit model [J]. Ann Plast Surg, 2003, 50(5): 523527.
  20. 20. Sclafani AP, Romo T 3rd, Jacono AA, et al. Evaluation of acellular dermal graft (alloderm) sheet for soft tissue augmentation: a 1year followup of clinical observations and histological findings [J]. Arch Facial Plast Surg, 2001, 3(2): 101103.