腹壁巨大缺损的Component Separation技术改良与并发症防治研究进展

Research Progress on the Improvement of Component Separation Technology and the Prevention and Treatment of Complications of Large Abdominal Wall Defects

摘要: 本文聚焦于腹壁巨大缺损的Component Separation技术(CST)改良与并发症防治研究进展。腹壁巨大缺损通常指腹壁组织因外伤、手术并发症、感染或先天性疾病等原因导致的直径大于10 cm或表面积超过50 cm²的缺损，其修复面临诸多挑战。CST作为一种重要修复手段，通过解剖性分离腹壁各肌肉层增加腹壁组织松弛度，实现巨大腹壁缺损的无张力闭合，但传统CST存在创伤大、并发症多等局限性。近年来，CST技术不断改良，包括改良型前路CST、后路CST (如TAR技术)、内镜及微创CST技术等。改良型前路CST通过精准识别并保护腹直肌的穿支血管，减少术后皮肤并发症；TAR技术通过后路入路切开腹直肌后鞘并游离腹横肌，实现更大的筋膜移位距离，适用于宽大腹壁缺损；内镜及微创CST技术减少皮下广泛剥离，降低术后切口并发症发生率，且具有创伤小、恢复快等优势。在临床应用方面，改良CST技术的适应证主要包括无法通过常规一期缝合闭合的腹壁巨大缺损。不同改良CST技术在缺损闭合程度、复发率及术后恢复等方面展现出各自的优势与局限。在并发症防治方面，需注重术前优化管理、术中精细操作及术后有效管理。未来研究方向包括新型生物材料与智能补片的开发、机器人辅助手术及高精度微创技术的引入、个体化治疗方案的制定以及多中心、大样本、长期随访的临床研究等，以进一步提升腹壁巨大缺损修复的安全性与有效性。

Abstract: This article focuses on research progress of the improvement of Component Separation technology (CST) and the prevention and treatment of complications of large abdominal wall defects. Large abdominal wall defects usually refer to defects of abdominal wall tissue with a diameter of more than 10 cm or a surface area of more than 50 cm² due to trauma, surgical complications, infection, or congenital diseases, and their repair faces many challenges. As an important repair method, CST increases the relaxation of abdominal wall tissues by anatomically separating each muscle layer of the abdominal wall and realizes the tension-free closure of huge abdominal wall defects, but traditional CST has the limitations of large trauma and many complications. In recent years, CST techniques have been continuously improved, including improved anterior CST, posterior CST (e.g., TAR technology), endoscopic and minimally invasive CST techniques. The modified anterior CST reduces postoperative skin complications by accurately identifying and protecting the perforating branch vessels of the rectus abdominis muscle. The TAR technique uses a posterior approach to cut the posterior rectus abdominis sheath and free the transverse abdominis muscle to achieve a larger fascial displacement distance, which is suitable for wide abdominal wall defects. Endoscopic and minimally invasive CST techniques reduce extensive subcutaneous dissection, reduce the incidence of postoperative incision complications, and have the advantages of less trauma and faster recovery. In terms of clinical application, the indications for modified CST technology mainly include large defects of the abdominal wall that cannot be closed by conventional primary sutures. Different modified CST techniques showed their own advantages and limitations in terms of defect closure degree, recurrence rate and postoperative recovery. In terms of prevention and treatment of complications, it is necessary to pay attention to preoperative optimal management, intraoperative fine operation and effective postoperative management. Future research directions include the development of new biomaterials and intelligent meshes, the introduction of robotic-assisted surgery and high-precision minimally invasive technologies, the formulation of individualized treatment plans, and multi-center, large-sample, long-term follow-up clinical studies, etc., to further improve the safety and effectiveness of the repair of large abdominal wall defects.