Исследования и практика в медицине №03 2021

Общий взгляд на технологии профилактики и лечения пациентов с послеоперационными вентральными грыжами

Номера страниц в выпуске:84-96
Проблема хирургического лечения послеоперационных вентральных грыж (ПОВГ) остается актуальной на сегодняшний день. По данным статистики, количество больных с данной проблемой увеличилось в 9 раз и более за последние 25 лет. В связи с этим ежегодно специалисты предлагают множество решений данной проблемы, и хирургу приходится работать в большом потоке информации для улучшения показателей реабилитации пациентов после оперативного вмешательства. Для написания статьи поиск литературы проводился по базам данных Google Scholar, CyberLeninka, а также был осуществлен анализ литературных источников «вручную».
На основании обзора сформированы следующие выводы. Причина ПОВГ мультифакторна. Отсутствует общепринятая доказательная градация факторов риска. Единой утверждённой системы подбора метода пластики передней брюшной стенки у больных с ПОВГ нет, выбор пластического материала и способа пластики зачастую индивидуальны. Значения критического уровня внутрибрюшного давления не уточнено, однако все авторы согласны, что его мониторинг должен стать рутинным. «Золотым стандартом» пластики апоневроза остаётся техника sublay, а inlay следует применять при невозможности выполнения sublay, операцию же onlay стоит рассматривать как способ резерва. В некоторых ситуациях необходимы комбинации техник. Всё больше внедряется лапароскопия в лечении ПОВГ, как в качестве ассистенции, так и в полном лечебном формате. Внедрение новых способов герниопластики, основанных на неконтролируемом разделении анатомических структур брюшной стенки, предъявляет особые требования к хирургической технологии: пластическому материалу, инструментально-техническому обеспечению, способу закрытия раны и фармакологическому сопровождению, особенно в условиях повышенного внутрибрюшного давления и натяжения тканей. Для лучшего вживления сетчатого импланта и повышения резистентности местных тканей, возможно применение препаратов пиримидинового ряда, такого как ксимедон.
Список исп. литературыСкрыть список
1. Mardonov BA, Isakov AM, Bakhriev BL, Kurbaniyazova AZ. linical and instrumental characteristics of postoperative ventral hernias in choosing the optimal method of plastic surgery. Achievements of science and education. 2020;(1(55)):54–60. (In Russian).
2. Charyshkin AL, Frolov AA. Problems of hernioplasty in pa-tients with incisional ventral hernias. Ulyanovsk Medical and Biological Journal. 2015;(2):39–46. (In Russian).
3. Shevchenko KV, Shcherbatykh AV, Sokolova SV. Results of prosthetic repair of the anterior abdominal wall in the treatment of postoperative ventral hernias. Acta Biomedica Scientifica. 2014;(3):57–61. (In Russian).
4. Vinnik YuS, Chaikin AA, Nazaryans YuA, Petrushko SI. Con-temporary view on the problem of treatment the patients with postoperative ventral hernias. Siberian Medical Review. 2014;(6(90)):5–13. (In Russian).
5. Romanov RV, Fedaev AA, Petrov VV, Khodak VA, Parshikov VV. Current state of the problem of intraperitoneal abdominal wall plasty with synthetic endoprostheses. Modern Technologies in Medicine. 2012:1(4):161–170. (In Russian).
6. Parshakov AA, Gavrilov VA, Samartsev VA. Prevention of complications in surgery of incisional hernias of the anterior abdominal wall: current state of the problem (review). Modern Technologies in Medicine. 2018:10(2):175–186.
7. Protasov AV, Kalyakanova IO, Kaitova ZS. The choice of an implant for hernioplasty of ventral hernias. RUDN Journal of Medicine. 2018;22(3):258–264. (In Russian).
https://doi.org/10.22363/2313-0245-2018-22-3-258-264
8. Styazhkina SN, Evteshin MD. Relevance of the problem of incisional ventral hernias. Science, education and culture. 2019;3(37):67–68. (In Russian).
9. Parshikov VV, Mironov AA, Anikina EA, Zaslavskaya MI, Alyokh-in AI, Kazantsev AA. Prosthetic plastic of the abdominal wall using light and ultra-light synthetic and titanium-containing materi-als in conditions of high bacterial contamination (experimental study). Modern Technologies in Medicine. 2015;7(4):64–71. (In Russian). http://doi.org/10.17691/stm2015.7.4.08
10. Shano VP, Gladkaya SV, Guryanov VG, Gumenyuk IV, Gordien-ko IV. Predicting the risk of developing abdominal compartment syndrome in patients with surgical pathology of the abdominal organs. MNS. 2014;2(57):153–158. (In Russian).
11. Timerbulatov VM, Timerbulatov SV, Timerbulatov MV, Gareev RN, Smyr RA. Clinical value of measurment of intra- abdominal pressure and its monitoring in emergency surgery. Grekov's Bulletin of Surgery. 2016;175(6):28–32. (In Russian). https://doi.org/10.24884/0042-4625-2016-175-6-28-32
12. Khadzhibaev AM, Gulomov FK. Prevention of abdominal compartment syndrome in strangulated ventral hernias by using "Tension-free" hernioalloplasty. 2016;(4):88–92. (In Russian).
13. Salakhov EK, Salakhov KK. Prevention of compartment syndrome after abdominal surgery. Kazan Medical Journal. 2016;97(1):84–89. (In Russian).
https://doi.org/10.17750/KMJ2016-84
14. Lazarenko VA, Ivanov SV, Ivanov IS, Tsukanov AV. Prevention of compartment syndrome in patients with plastic of ventral hernias. Kursk Scientific and Practical Bulletin "Man and His Health". 2015;(2):35–37. (In Russian).
15. Mezentsev EN, Shutov YuM, Schedrin AS. Typological ap-proaches to correction of abdominal compression syndrome at patients with emergency surgical abdominal diseases. Journal of Siberian Medical Sciences. 2015;(2):31. (In Russian).
16. Kasumyan AS, Sokolovskiy SS. Noninvasive way of intra-ab-dominal pressure change registration. Smolensk Medical Almanac. 2017;(1):174–179. (In Russian).
17. Matyushko DN, Turgunov EM, Zlotnik A. Intraabdominal hy-pertension and compartment syndrome: review of literature. Science and Healthcare. 2015;(1):22–32. (In Russian).
18. Charyshkin AL, Frolov AA. Gernioplasty comparative results at patients with big postoperative ventral hernias. Ulyanovsk Medical and Biological Journal. 2014;(1):55–63. (In Russian).
19. Helfand BR, Protsenko DM, Podachyn PV, Chubchenko SV, Lapshyna IYu. Abdominal hypertension syndrome: the state of the problem. MNS. 2015;(7(70)):41–50. (In Russian).
20. Imangazinov SB, Kairkhanov EK, Kazangapov RS. Post-operative ventral hernia. surgery and prevention of wound complications. Literature review. Science and Healthcare. 2019;21(1):29–41. (In Russian).
21. Raylyanu R.R., Botezatu A.A. The effect of combined hernio-plasty on the ventilation function of the lungs of patients with median abdominal hernias. Materials of the XII Congress of Sur-geons of Russia; Rostov-on-Don: 2015, 106–107. (In Russian).
22. Tarasova NK, Dynkov SM, Pozdeev VN, Teterin AYu, Osmano-va GSh. Analysis of the causes of recurrent postoperative ventral hernias. Pirogov N.I. Russian Journal of Surgery. 2019;10:36-42.(In Russian). https://doi.org/10.17116/hirurgia201910136
23. Maksyatkina LV, Abatov NT, Akhmaltdinova LL, Badyrov RM, Troshin VV. Application of bioimplants in plastic surgery of ante-rior abdominal wall defects. Kazakh National Medical University. 2019;(1):307–312. (In Russian).
24. Golovin RV, Nikitin NA. The Assessment of Different Combi-nation Prosthetic Repair Techniques and Prognostic Criteria for Early Wound Complications in Median Incisional Ventral Herni-as. Modern Technologies in Medicine. 2015;7(2):105–112. (In Russian).
25. Maslakova ND, Vasilevskiy VP, Novitskiy AA, Zhotkovskaya TS, Fleerov AO, Makarchik VV, et al. Technical solutions for hernio-plasty of ventral hernias using mesh grafts. Journal of the Grodno State Medical University. 2014;(2(46)):97–99. (In Russian).
26. Kaliev DR, Kchibekov EA, Zurnadzh'yants VA, Kokhanov AV, Serdyukov MA. Analysis of various types of polypropylene im-plants for surgical treatment of ventral hernias. Astrakhan Medical Journal. 2017;12(4):6–12. (In Russian).
27. Parshikov V.V. Inflammatory complications of abdominal wall prosthetic repair: diagnosis, treatment and prevention (review). Modern Technologies in Medicine. 2019;11(3):158–178. (In Rus-sian). http://doi.org/10.17691/stm2019.11.3.19
28. Anurov MV, Titkova SM, Ettinger AP. Classification of pros-theses for abdominal hernia repair: analytical literature review. Vestnik RGMU. 2015;(1):5–10. (In Russian).
29. Sukovatykh BS, Valuyskaya NM, Pravednikova NV, Gerasim-chuk EV, Mutova TV. Preventive endoprosthesis implantation in the anterior abdominal wall after surgery intervention on the abdominal cavity and retroperitoneum. Annals of Surgery. 2015;(3):5–12. (In Russian).
30. Parshikov VV, Khodak VA, Samsonov AA, Gradusov VP, Ro-manov RV. Application of tension-free plastic of abdominal walls and synthetic endoprosthesis under conditions of bacte-rial contamination. Wounds and Wound Infections. The prof. B.M.Kostyuchenok Journal. 2014;1(2):9–15. (In Russian). https://doi.org/10.25199/2408-9613-2014-1-2-9-15
31. Polynskiy AA, Chernyshov TM. Eventratsiya. Eventration. Principles of diagnosis and medical treatment. Journal of the Grodno State Medical University. 2014;(2(46)):10–14.
32. Sukovatykh BS, Zatolokina MA, Mutova TV, Valuyskaya NM, Zhukovsky VA, Philipenko TS, et al. The choice of lightweight synthetic material for replacement of the abdominal wall (experi-mental study). Grekov's Bulletin of Surgery. 2019;178(2):46–51. (In Russian). https://doi.org/10.24884/0042-4625-2019-178-2-46-51
33. Chevrel JP, Rath AM. Classification of incisional hernias of the abdominal wall. Hernia. 2000 Mar 1;4(1):7–11.
https://doi.org/10.1007/BF01230581
34. Rios A, Rodriguez JM, Munitiz V, Alcaraz P, Pérez D, Parril-la P. Factors that affect recurrence after incisional herniorrhaphy with prosthetic material. Eur J Surg. 2001 Nov;167(11):855–859. https://doi.org/10.1080/11024150152717706
35. Parshikov VV, Loginov VI. Components Separation Technique in Treatment of Patients with Ventral and Incisional Hernias (Re-view). Modern Technologies in Medicine. 2016;8(1):183–194. http://doi.org/10.17691/stm2016.8.1.24
36. Pio JRS, Damsgaard TE, Momsen O, Ivan V, Larsen J. Repair of Giant Incisional Hernias with Polypropylene Mesh: A Retrospec-tive Study. Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery. 2003 Jan 1;37(2):102–106.
https://doi.org/10.1080/02844310310005630
37. Godara R, Garg P, Raj H, Singla SL. Comparative evaluation of “Sublay” versus “Onlay” meshplasty in ventral hernias. Indian J Gastroenterol. 2006 Aug;25(4):222–223.
38. de Vries Reilingh TS, van Geldere D, Langenhorst B, de Jong D, van der Wilt GJ, van Goor H, et al. Repair of large midline inci-sional hernias with polypropylene mesh: comparison of three operative techniques. Hernia. 2004 Feb;8(1):56–59.
https://doi.org/10.1007/s10029-003-0170-9
39. den Hartog D, Dur AHM, Tuinebreijer WE, Kreis RW. Open surgical procedures for incisional hernias. Cochrane Database Syst Rev. 2008 Jul 16;(3):CD006438.
https://doi.org/10.1002/14651858.CD006438.pub2
40. Bittner R, Bingener-Casey J, Dietz U, Fabian M, Ferzli G, For-telny R, et al. Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias (International Endohernia Society [IEHS])-Part III. Surg Endosc. 2014 Feb;28(2):380–404. https://doi.org/10.1007/s00464-013-3172-4
41. Parshikov VV, Loginov VI, Baburin AB, Romanov RV. Posterior separation: indications, techniques and results. Modern Prob-lems of Science and Education. 2018;(5):12–15.
42. Vorst AL, Kaoutzanis C, Carbonell AM, Franz MG. Evolution and advances in laparoscopic ventral and incisional hernia re-pair. World J Gastrointest Surg. 2015 Nov 27;7(11):293–305. https://doi.org/10.4240/wjgs.v7.i11.293
43. Agapov MV, Gorsky VA, Zryanin AM, Sklyar VF, Sadovnikov SV. Application of laparoscopic technologies in the treatment of hernias of the anterior abdominal wall. Materials of the XII con-ference "Topical issues of Herniology". Rostov-on-Don: 2015, 8–9.
44. Matveev NL, Bogdanov DYu, Ukhanov AI. The place of lapa-roscopic technology in the treatment of postoperative ventral hernias. Materials of the XII Congress of Surgeons of Russia. Ros-tov-on-Don: 2015, 87–88.
45. Kotlobovsky VI. Non-tensioning alloplasty of hernias of the anterior abdominal wall with laparoscopic support. XVI Con-gress of the Russian Society of Endoscopic Surgeons. Aktobe, Republic of Kazakhstan, 2013.
46. Samotrueva MA, Tsibizova AA, Yasenyavskaya AL, Oze-rov AA, Tyurenkov IN. Pharmacological activity of pyrimidine derivatives. Astrakhan Medical Journal. 2015;10(1):12–29.
47. Izmaylov AG, Dobrokvashin SV, Volkov DE, Pyrkov VA, Za-kirov RF, Davlet-Kildeev ShA, et al. Patient selection for anterior abdominalwall hernias surgery with postoperative wound com-plications prevention. Bulletin of Modern Clinical Medicine. 2019;12(5):30–34.
https://doi.org/10.20969/VSKM.2019.12(5).30-34
48. Izmaylov A.G., Dobrokvashin S.V., Volkov D.E., Pyrkov V.A., Zakirov R.F., Davlet-Kil'deev Sh.A. et al. Concept of prevention and treatment of postoperative wound complications in surgical patients. Practical Medicine Journal. 2017;6(107):55–54.
49. Struchkov AA, Sokolov RA, Gordinskaya NA, Melnikova NB, Pogodin IE. Antimicrobial and reparative capabilities of a gel containing pyrimidine derivatives, sodium succinate and antibacterial agents in the local treatment of burn wounds. Bioradicals and Antioxidants. 2018;5(1):47–56.
50. Cherkasov MF, Khindikaynen AYu, Pomazkov AA. Methods of diagnosis, prevention and treatment of complications of hernia repair. Astrakhan medical journal. 2016;11(4):50–54.
51. Magomedov MM, Magomedbekov RE, Ismailov GM. System-ic inflammatory response in alloplastic treatment of the inguinal hernias. Bulletin of New Medical Technologies. Electronic Edi-tion. 2017;(2):139–144.
https://doi.org/10.12737/article_59099e6cbbb6f5.58108559
52. Sarbaeva NN, Ponomareva YuV, Milyakova MN. Macro-phages: diversity of phenotypes and functions, interaction with foreign materials. Genes and cells. 2016;11(1):9–17.
53. Plecheva DV, Okroyan VP, Ibragimov TR, Galimov OV, Khanov VO. Improvement of reparative regeneration in surgery. Perm Medical Journal. 2018;35(3):35–38.
https://doi.org/10.17816/pmj35332-38
Количество просмотров: 801
Предыдущая статьяОсновные компоненты протокола ускоренного выздоровления в хирургии опухолей легкого
Следующая статьяРоль биомаркеров острого повреждения почек в прогнозировании функциональных результатов хирургического лечения у больных локализованным раком почки
Прямой эфир