[初始:流行病学,证据和指导方针]
1Lehrstuhl für Allgemeinchirurgie, Medizinische Fakultät, Sigmund Freud PrivatUniversität Wien, Freudplatz 3, 1020, Wien, Österreich. dr.fortelny@gmail.com.
Chirurgie (Heidelberg, Germany)
|December 11, 2023
概括
通过最佳的腹部关闭技术来预防切口. 建议使用中线腹腔切除术的短针法,并为高风险患者增加网格,以减少发生.
科学领域:
- 手术创新 在外科创新.
- 腹部外科手术 腹部外科手术
- 预防 Hernia 预防
背景情况:
- 切口影响到30%的患者在腹部手术后的2年内,在5年后的比例达到60%.
- 患者的并发症,手术方法和关闭技术显著影响的发展.
- 流行病学数据强调了工业化国家腹部外科手术的普遍性.
研究的目的:
- 为腹壁关闭提供基于证据的建议.
- 概述预防性网格增大在预防切口的策略.
主要方法:
- 进行了简短的文献综述.
- 现有的临床指导方针被纳入.
- 总结了目前关于手术技术和网格增大现有证据.
主要成果:
- 选择性中线腹腔切除术的短针技术得到了高级证据的支持,作为标准程序.
- 患有风险因素增加的患者 (肥胖,腹主动脉疾病,腹部直径扩张) 除了短针技术外,还可以从预防性网状增强 (onlay或sublay) 中受益.
- 紧急腹腔切除术需要仔细考虑相对于关闭技术的感染风险.
结论:
- 最少侵入性腹腔镜接入是避免切口的主要方法.
- 对于中线腹腔切除术,建议使用短针技术.
- 对于有风险因素的患者,应考虑增加网格,以进一步预防切口.
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