目的 评价三维可视化(three-dimensional visualization,3DV)技术在复杂腹壁缺损重建中的应用价值.方法 回顾性收集2021年9月至2022年9月期间四川大学华西医院收治的复杂腹壁切口疝患者的临床资料.采用3DV技术重建并用Medraw软件分析腹壁缺损面积,据此进行腹壁缺损分类和分区,计算疝囊/腹腔容积比,预估补片大小,记录术后24 h及48 h时的腹腔内压力值以及手术时间和术后并发症情况.结果 本研究共收集到48例复杂腹壁切口疝患者,其中正中线腹壁切口疝30例,其他部位18例.中型疝13例、大型疝19例、巨大疝16例.48例患者通过3DV技术测量的腹壁缺损面积为(92.11±60.25)cm2,疝囊/腹腔容积比为(7.7±5.2)％,术中实际测量的腹壁缺损面积为(89.20±57.38)cm2,Pearson相关性分析结果显示术前3DV技术测量和术中实际测量的腹壁缺损面积值呈正相关(r=0.959,P＜0.001).手术时间为(73.5±8.2)min,术后肛门排气时间为(31.66±15.32)h,术后 24 h 和 48 h 时的腹腔内压力分别为(13.50±2.12)mmHg、(11.39±1.42)mmHg,住院时间为(7.12±1.21)d.48例患者中术后共有7例(14.6％)患者发生并发症,均经保守治疗后痊愈,无非计划再次手术.所有患者均获得随访,随访时间18～32个月、中位时间为26个月,均未见远期疝复发.结论 从本组资料分析结果看,应用3DV技术评估复杂腹壁切口疝可以辅助疝外科医师作出正确抉择,安全而有效.
Application of three-dimensional visualization technique in complex abdominal incisional hernia:an experience of 48 cases
Objective To evaluate the application value of three-dimensional visualization(3DV)technique in the reconstruction of complex abdominal incisional hernia.Methods The clinical data of the patients with complex abdominal incisional hernia admitted to the West China Hospital of Sichuan University from September 2021 to September 2022 were collected.The area of abdominal wall defects was analyzed by Medraw software and reconstructed using 3DV technique,then the classifying and partition of abdominal wall defects were performed,the hernia sac/intraabdominal volume ratio was calculated,patch size was estimated,and intraabdominal pressure values at 24 h and 48 h after surgery as well as operation time,complications were recorded.Results A total of 48 patients with complex abdominal incisional hernia were enrolled,including 30 cases of midline abdominal incisional hernia and 18 cases of other sites.There were 13 cases of moderate hernia,19 cases of large hernia,and 16 cases of huge hernia.The abdominal wall defect area measured by 3DV technique for the 48 patients was(92.11±60.25)cm2,the hernia sac/intraabdominal volume ratio was(7.7±5.2)％,and the actual defect area measured intraoperatively was(89.20±57.38)cm2.Pearson correlation analysis showed a positive correlation between the preoperative 3DV measurement and intraoperative measurement(r=0.959,P＜0.001).The operation time was(73.5±8.2)min,postoperative anal exhaust time(31.66±15.32)h,intraabdominal pressures at 24 h and 48 h postoperatively were(13.50±2.12)mmHg and(11.39±1.42)mmHg,respectively.The patient's hospitalization time was(7.12±1.21)d.Among the 48 patients,7 cases(14.58％)experienced complications after surgery,recovered smoothly after conservative treatment and no unplanned reoperation was required.All patients were followed up for 18-32 months with a median time of 26 months,and no long-term hernia recurrence was observed.Conclusion From the analysis results of this study,it can be seen that the application of 3DV technique to evaluate complex abdominal wall defects can assist hernia surgeons to make a correct choice and has a better safety and effect.
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