Исследования и практика в медицине №03 2021

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

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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.
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Предыдущая статьяОсновные компоненты протокола ускоренного выздоровления в хирургии опухолей легкого
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