腹壁巨大切口疝的修补是很困难的手术，在一些特殊的病例中，由于患者的全身情况严重恶化使得切口疝无法修补，如年老、病态性肥胖及呼吸功能严重紊乱的患者。近年来，随着生物材料在疝和腹壁外科的广泛应用，对巨大腹壁切口疝的治疗已取得了明显进展。
Objective Surgical repair for giant lower ventral hernia is facing challenge owing to enormous tissue defect and the critical structures of pubis and il iac vessels. To investigate the method and curative effect of intraperitoneal onlay mesh (IPOM) combined with Sublay for compound repair of giant lower ventral hernia. Methods Between November 2008 and August 2010, 26 patients with giant lower ventral hernia were treated. There were 15 males and 11 females with an averageage of 61 years (range, 36-85 years), including 11 cases of lower midl ine incisional hernia due to radical rectal procedures, 6 cases of Pfannenstiel incisional hernia due to radical uterectomy, and 9 cases of lower midl ine incisional hernia due to radical cystectomy. Of them, 11 patients underwent previous repair procedures. The mean time from hernia to admission was 8.5 years (range, 1-15 years). All hernias were defined as M3-4-5W3 according to classification criteria of Europe Hernia Society. The mean longest diameter was 17.5 cm (range, 13-21 cm) preoperatively. Before 2 weeks of operation, abdominal binder was tightened gradually until the contents of hernia sac were reduced totally, and then reconstruction of abdominal wall was performed with compound repair of IPOM and Sublay technique. Results All of compound repair procedures were performed successfully. The mean hernia size was 112.5 cm2 (range, 76.2-160.6 cm2); the mean polypropylene mesh size was 120.4 cm2 (range, 75.3-170.5 cm2); and the mean compound mesh size was 220.0 cm2 (range, 130.4-305.3 cm2). The mean operative time was 155.5 minutes (range, 105.0-195.0 minutes) and the mean postoperative hospital ization time were 12 days (range, 7-16 days). Incisions healed by first intention; 4 seromas (15.4%) and 3 chronic pains (11.5%) occurred and were cured after symptomatic treatment. All patients were followed up 3-24 months (mean, 14.5 months). No recurrence and any other discomforts related to repair procedure occurred. Conclusion Compound repair of IPOM and Sublay is a safe and efficient surgical procedure for giant lower ventral hernia, owing to its characteristics of adequate patch overlap and low recurrence rate. Perioperative management and operative technology play the key role in the success of repair procedure.
目的探讨腹壁大切口疝和巨大切口疝治疗经验。方法对我院采用补片行开放式腹壁大切口疝和巨大切口疝修补术的51例患者临床资料进行回顾性分析。结果采用肌前补片修补法3例，肌肉间补片修补法3例，肌后腹膜前补片修补法39例，腹腔内补片修补法6例。 手术时间109～195 min，平均135.2 min; 术中出血15～90 ml，平均35.6 ml；术中无血管和内脏损伤等并发症。 术后3～7 d（平均4.9 d）下床活动; 住院时间7～19 d，平均9.7 d。 2例患者术后出现浆液肿，经穿刺抽吸、负压吸引和腹带加压包扎后治愈。51例患者随访12～36个月（平均24.5个月），3例（5.9%）患者复发，后行开放式腹腔内补片修补手术，恢复良好，无再复发。所有病例无慢性疼痛。结论应用补片行开放式腹壁大切口疝和巨大切口疝修补术是一种安全、可靠的方法，复发率低。
Objective To evaluate effect of massive and complex incisional hernia or defect of abdominal wall by using prosthetic mesh. Method The clinical data of 112 patients with massive and complex incisional hernia or defect of abdominal wall from February 2003 to February 2016 were analyzed retrospectively. Results Sixty-three cases were repaired by placing artificial mesh between the peritoneum and the musculus rectus abdominis and 49 cases by opening intraperitoneal mesh placement. The primary healing occurred in 108 cases, the incision infection occured in 4 cases, the seroma occurred in 7 cases. The stretched feeling was found in 39 cases and the mild pain occurred in 17 cases in the operative area at early term after operation. One hundred and two patients were followed up for 9–156 months (mean 78.6 months), the recurrence was observed in 3 cases (2.94%). Conclusion Repair of massive and complex incisional hernia or defect of abdominal wall by using prosthetic mesh has some advantages of minimal invasiveness, rapid convalescence, and low recurrent rate.