CAJ | 학술논문

目的：评价生物补片用于污染或感染状态下腹壁缺损一期修复的安全性和有效性。方法 2010年4月以来17例腹壁缺损手术均因肠外瘘或肠造口、切口感染或同时肠道手术等原因而处于感染或污染状态：切口疝6例，腹股沟嵌顿疝1例，肠外瘘8例、直肠癌柱状切除术2例。腹壁缺损范围在(3 cm ×2 cm)～(6 cm×17 cm)，均采用同种异体脱细胞真皮基质补片（RENOV(R)瑞诺）作为修补材料，修补方法包括平片修补（Lichtenstein手术）1例，嵌入式修补(Inlay)2例，肌后筋膜前修补(Sublay)2例，腹腔内置片修补技术（Intraperitoneal onlay mesh technique，IPOM）12例。结果创面一期缝合的12例患者中除1例脂肪液化外均甲级愈合，创面开放的5例患者，经敷料交换或者VAC治疗后愈合。平均随访(8.3±4.5)个月（1～15个月），未发现切口疝发生或复发。1例患者出现修补部位膨出，另1例患者在术后2个月时诉补片固定处腹壁疼痛，后自行缓解。结论生物补片能够安全、有效地一期修复感染或污染状态下的腹壁缺损、减少切口疝发病率，但长期结果有待于进一步随访。
목적：평개생물보편용우오염혹감염상태하복벽결손일기수복적안전성화유효성。방법 2010년4월이래17례복벽결손수술균인장외루혹장조구、절구감염혹동시장도수술등원인이처우감염혹오염상태：절구산6례，복고구감돈산1례，장외루8례、직장암주상절제술2례。복벽결손범위재(3 cm ×2 cm)～(6 cm×17 cm)，균채용동충이체탈세포진피기질보편（RENOV(R)서낙）작위수보재료，수보방법포괄평편수보（Lichtenstein수술）1례，감입식수보(Inlay)2례，기후근막전수보(Sublay)2례，복강내치편수보기술（Intraperitoneal onlay mesh technique，IPOM）12례。결과 창면일기봉합적12례환자중제1례지방액화외균갑급유합，창면개방적5례환자，경부료교환혹자VAC치료후유합。평균수방(8.3±4.5)개월（1～15개월），미발현절구산발생혹복발。1례환자출현수보부위팽출，령1례환자재술후2개월시소보편고정처복벽동통，후자행완해。결론 생물보편능구안전、유효지일기수복감염혹오염상태하적복벽결손、감소절구산발병솔，단장기결과유대우진일보수방。
Objective To evaluate the safety and efficacy of biological meshes (human aceUular dermal matrix mesh) in single-stage repair of infected or contaminated abdominal abdominal wall defects and abdominal hernias. Methods Seventeen patients with abdominal wall defects or abdominal hernias were enrolled. The wounds of all these patients were infected or contaminated due to the existence of enterocutaneous fistula or stoma, wound infection and synchronous colonic resection. The diagnosis included enterocutaeneous fistula 8 cases, incisional hernia 6 cases, incarcerated inguinal hernia 1 case and cylindrical abdominoperineal resection for rectal cancer for 2 cases. The sizes of abdominal defects ranged from 3 cm × 2 cm to 6 cm × 17 cm, and all the cases were repaired with human acellular dermal matrix mesh(RENOV(R)). Most of the patients were repaired with intraperitoneal onlay mesh technique( IPOM, for 12 cases), and other methods included Lichtenstein operation for 1 case, inlay repair for 2 cases and sublay for 2 cases. Results All the 17 patients recovered uneventfully. For 12 patients, the wounds were sutured at operation and only one case of delayed healing occurred due to fat liquefaction. For the other 5 patients, the wounds were left open and healed after vacuum assisted closure (VAC) therapy or wet- to- dry dressing changes. On follow up for 8.3 ±4.5 months ( 1 to 15 months), no occurrence of incisional hernia or recurrence was found. laxity of abdominal wall occurred in one case. A patient complained intermittent pain of the site of suture for mesh fixing two months after operation and the pain resolved spontaneously one month later. Conclusions The biological mesh, acellular dermal matrix mesh, could be used in single- stage repair of infected or contaminated abdominal wall defects safely and effectively, although the long-term outcome still needs further evaluation.