中国实用外科杂志

中国实用外科杂志 ›› 2025, Vol. 45 ›› Issue (04): 457-460.DOI: 10.19538/j.cjps.issn1005-2208.2025.04.13

• 论著 • 上一篇    下一篇

应用CT三维重建技术评估肥胖对切口疝修补术后腹壁功能恢复及疝复发影响研究

杨荣铎，李绍春，孟云潇，黄    磊，蔡    昭，唐健雄，李绍杰   

  1. 复旦大学附属华东医院普外科，上海 200040  
  • 出版日期:2025-04-01 发布日期:2025-04-30

  • Online:2025-04-01 Published:2025-04-30

摘要： 目的    探讨肥胖对切口疝修补术后腹直肌恢复及疝复发的影响，并建立基于CT三维重建的客观评价方式。方法    回顾性分析2023年2月至2024年8月复旦大学附属华东医院普外科收治的行补片修补术后时间>3个月的73例腹壁切口疝（缺损最大距离≥4 cm）病人的临床资料。根据BMI分为正常组（18.5~<24.0）、超重组（24.0~<28.0）、肥胖组（≥28.0）。使用3D Slicer 5.7.0软件对术前、术后腹部CT进行三维重建，并测量腹直肌体积。结果    补片修补术后三维重建图像显示，切口疝病人腹壁形态更加均匀平整，腹直肌的解剖及功能得到一定程度恢复，体积显著增加。3组病人手术前后腹直肌体积增加的绝对值差异无统计学意义（P>0.05）。正常组术后腹直肌体积增加百分比高于超重组和肥胖组［（12.1±2.2）% vs. （9.4±1.6）% vs. （7.9±2.0）%］，且两两比较差异均有统计学意义（t=5.159、6.059，P<0.05）。结论    肥胖因素使切口疝病人在补片修补术后腹直肌恢复能力显著降低，可能是其术后复发率升高的潜在机制。

关键词: 肥胖, 切口疝, 腹直肌体积, 三维重建, 疝复发

Abstract: To analyze the impact of obesity on the recovery of the rectus abdominis muscle after mesh repair of incisional hernia via establishing an objective method with computed tomography (CT) scan-based 3D reconstruction technology, and to investigate the mechanism underlying the elevated recurrence rate associated with obesity. Methods    A retrospective analysis was conducted on the clinical data from 73 patients with abdominal incisional hernia (maximum defect diameter ≥4 cm) who underwent mesh repair at the Department of General Surgery, Huadong Hospital affiliated to Fudan University between February 2023 and August 2024, and had a postoperative period exceeding 3 months. Patients were stratified into three groups based on BMI: normal group (18.5-<24.0), overweight group (24.0-<28.0), and obesity group (≥28.0). Preoperative and postoperative abdominal CT images were reconstructed three-dimensionally using 3D Slicer software (version 5.7.0) to quantify rectus abdominis muscle volume. Results    3D reconstruction imaging of the abdominal wall in incisional hernia patients following mesh repair demonstrated improved morphological uniformity of the abdominal wall and partial anatomical and functional recovery of the rectus abdominis muscle accompanied by a significant volume increase. No statistically significant intergroup differences were observed in absolute preoperative-to-postoperative volume increments of rectus abdominis muscle among the three cohorts (P>0.05). The normal group exhibited a greater percentage increase in rectus abdominis muscle volume compared to the overweight and obesity groups ［(12.1±2.2)% vs. (9.4±1.6)% vs. (7.9±2.0)%)］, with statistically significant pairwise differences (t=5.159 and 6.059, P<0.05). Conclusion    The 3D reconstruction indicates that the obesity significantly reduces the recovery ability of the rectus abdominis muscle in patients with incisional hernia after mesh repair, suggesting that obesity-induced impairment of muscle recovery is a potential mechanism for the increased recurrence rate in obese patients.

Key words: obesity, incisional hernia, rectus abdominis muscle volume, 3D reconstruction, hernia recurrence ,