腹壁切口疝诊疗指南(2024版)
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Guidelines for diagnosis and treatment of abdominal wall incision hernia (2024 edition)
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    摘要:

    切口疝是一类医源性疾病,具有形态多样,差异性大,分类繁杂等特点,临床治疗复杂,具有挑战性和不确定性。随着切口疝的诊断、手术方式、补片材料相关研究取得长足的进展。国内疝与腹壁外科专家在《腹壁切口疝诊断和治疗指南(2018年版)》的基础上,经过协商讨论,并结合循证医学证据评价标准,针对复杂腹壁状态、腹壁功能不全、切口疝治疗原则、腹壁疝缺损关闭方法、围手术期处理、随访宣教等具体问题进行了增补或修订。旨在进一步提高我国腹壁切口疝诊治水平。

    Abstract:

    Incisional hernia is an iatrogenic condition characterized by diverse forms, significant variability, and complex classification. It presents challenges and uncertainties in clinical treatment. Significant progress has been made in the diagnosis of incisional hernias, surgical techniques, and the development of prosthetic materials. Building upon the "Guidelines for the Diagnosis and Treatment of Abdominal Wall Incisional Hernia (2018 Edition)," domestic experts in hernia and abdominal wall surgery have conducted discussions and revisions. These updates, guided by evidence-based medical evaluation standards, address issues such as complex abdominal wall conditions, abdominal wall dysfunction, principles of hernia treatment, methods for defect closure, perioperative management, and follow-up and patient education. The aim is to further enhance the diagnostic and treatment standards for abdominal wall incisional hernias in China.

    图1 疝囊容积比示意图:计算疝囊容积比对于评估腹壁疝的分型,判断是否存在LOD以及预判术后腹腔间室综合征的发生风险有重要意义;计算方法可应用Sabbagh法,即疝囊容积比=疝囊容积/(腹腔容积+疝囊容积),本例疝囊容积比=20/(80+20)=20%Fig.1 Diagram of volume ratio of the hernia sac: the calculation of the volume ratio of hernia sac is of great significance for evaluating the classification of abdominal wall hernia, determining the presence of LOD, and predicting the risk of postoperative abdominal compartment syndrome; the Sabbagh method can be applied for this calculation, with the hernia sac volume ratio defined as: volume ratio of the hernia sac=hernia sac volume/(abdominal cavity volume+hernia sac volume), and in this example, the hernia sac volume ratio=20/(80+20)=20%
    图2 修补材料在腹壁的放置层次示意图:分为腹壁肌肉前(onlay)(A)、腹壁肌肉后(腹膜前)(sublay)(B)、腹腔内腹膜面(underlay或IPOM)(C)Fig.2 Schematic diagram of placement levels of repair materials in the abdominal wall: the placement is categorized into pre-abdominal muscle (onlay) (A), post-abdominal muscle (preperitoneal or sublay) (B), and intraperitoneal peritoneal surface (underlay or IPOM) (C)
    表 1 证据级别和推荐标准Table 1 Evidence level and recommendation criteria
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.腹壁切口疝诊疗指南(2024版)[J].中国普通外科杂志,2025,34(3):397-408.
DOI:10.7659/j. issn.1005-6947.250046

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  • 收稿日期:2024-11-28
  • 最后修改日期:2025-01-24
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  • 在线发布日期: 2025-04-14