切口疝、腹壁力学与外科技术
作者:
通讯作者:
作者单位:

中山大学附属第六医院 胃肠、疝与腹壁外科,广东 广州 510655

作者简介:

陈双负责立题与修改,江志鹏负责撰写和校对。

基金项目:

广东省科技厅科技计划基金资助项目(KYPYJ2022015)。


Incision hernia, abdominal wall mechanics and surgical techniques
Author:
Affiliation:

Department of Gastrointestinal and Hernia Surgery, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou 510655, China

Fund Project:

  • 摘要
  • |
  • 图/表
  • |
  • 访问统计
  • |
  • 参考文献
  • |
  • 相似文献
  • |
  • 引证文献
  • |
  • 资源附件
  • |
  • 音频文件
  • |
  • 视频文件
    摘要:

    切口疝的治疗一直是腹壁外科的难点,因为还有很多问题至今尚未厘清和解决。要加深对切口疝的认识,需要从其本质及发生、发展的原理开始,这离不开对腹壁结构与力学特点的探索。另外,腹壁是一有多种功能的复杂器官,外科技术需要重视腹壁功能才能做到“从结构到功能”的统一。笔者从“腹壁功能单位”、切口疝在力学作用下的发展、腹壁的力学特点、腹壁的功能特点等多个层面对相关问题进行探讨,并对当下切口疝外科技术的一些问题展开讨论,提出了改进的方向和观点,旨在增进外科医生对切口疝的理解以更好地运用和创新腹壁外科的技术。

    Abstract:

    The treatment of incisional hernia has always been a difficult problem in abdominal wall surgery because there are still many issues that have not been clarified and resolved. To deepen the understanding of incisional hernia, we need to start with its essence, occurrence, and the principle of its occurrence and development, which cannot be separated from the exploration of the structure and mechanical characteristics of the abdominal wall. In addition, the abdominal wall is a complex organ with multiple functions, and surgical techniques need to focus on its functions in order to achieve to unity of "from structure to function". Here, the authors discuss relevant issues from multiple perspectives such as "functional unit of abdominal wall", the development of incisional hernia under mechanical action, the mechanical characteristics of the abdominal wall, and the functional characteristics of the abdominal wall, address some issues in current incisional hernia surgical techniques, and propose the directions and strategies for improvement, with the aim of enhancing surgeons' understanding of incisional hernia for better use and innovation of abdominal wall surgery techniques.

    图1 腹壁功能单位及张力示意图 注:腹部横截面腹壁功能单位(腹壁肌肉+筋膜),前、侧、后方功能单位左右对称;前腹壁上弧线表示腹壁在任何两点都存在张力Fig.1 Diagrammatic sketch of functional unit of abdominal wall and tension force Note: The functional unit of the abdominal wall (abdominal wall muscles + fascia) in the cross-section of the abdomen are symmetrical on the left and right sides in the anterior, lateral, and posterior directions; the curved line on the anterior abdominal wall represents the tension present in the abdominal wall at any two points
    图2 腹腔镜下切口疝视野 注:患者 男,62岁,阑尾切口疝4年半;腹腔镜视野下,腹壁缺损呈类似圆形,在疝囊内,有“小梁”样结构(箭头所指)Fig.2 Laparoscopic vision of incisional hernia Note: Male patient, 62 years old, with appendectomy incisional hernia for 4 and a half years; under the laparoscopic view, the abdominal wall defect appears as a circular shape inside the hernia sac, with a small beam structure (indicated by the arrow)
    图3 切口疝CT图像(矢状位) 注:患者 男,72岁,结肠癌术后腹部切口疝2年余;CT图像示,疝囊受IAP和重力作用向前凸起,并向下发展,呈倒“L”形(箭头所指)Fig.3 CT image of incisional hernia (sagittal position) Note: Male patient, 72 years old, with abdominal incisional hernia for more than 2 years after colon cancer surgery; CT image shows that the hernia sac protrudes forward and develops downward under the influence of IAP and gravity, forming an inverted L shape (indicated by the arrow)
    图4 切口疝CT图像(矢状位) 注:患者 女,56岁,乙状结肠癌术后切口疝4年余;CT图像示,疝囊向前凸起,并向下发展,呈倒“L”形;短箭头间的距离为重力作用下,向下发展的疝囊Fig.4 CT image of incisional hernia (sagittal position) Note: Female patient, 56 years old, with incisional hernia for more than 4 years after sigmoid colon cancer surgery; CT image shows that the hernia sac protrudes forward and develops downward, forming an inverted L shape; the distance between the short arrows represents the hernia sac that is developing downward under the influence of gravity
    参考文献
    相似文献
    引证文献
引用本文

陈双,江志鹏.切口疝、腹壁力学与外科技术[J].中国普通外科杂志,2023,32(10):1453-1459.
DOI:10.7659/j. issn.1005-6947.2023.10.002

复制
分享
文章指标
  • 点击次数:
  • 下载次数:
历史
  • 收稿日期:2023-02-19
  • 最后修改日期:2023-03-31
  • 录用日期:
  • 在线发布日期: 2023-11-02