外科理论与实践

外科理论与实践 ›› 2026, Vol. 31 ›› Issue (01): 32-35.doi: 10.16139/j.1007-9610.2026.01.06

• 指南与共识 • 上一篇    下一篇

《腹壁切口疝诊疗指南（2024版）》解读

陈双(), 周太成   

  1. 中山大学附属第六医院疝和腹壁外科， 广东省结直肠盆底疾病研究重点实验室，广州中六生物医学创新研究院， 广东 广州 510655
  • 收稿日期:2026-01-08 出版日期:2026-02-25 发布日期:2026-04-21
  • 通讯作者: 陈双，E-mail: chensh223@mail.sysu.edu.cn
  • 作者简介:作者贡献/Authors’ contributions

    周太成负责资料收集和撰写；陈双负责提纲制定和指导、审查及修订。

  • 基金资助:
    国家临床重点专科(2012649);中国博士后科学基金(2024M763787);国家自然科学基金青年科学基金（C类）(82500609)

Interpretation of guideline for the diagnosis and treatment of abdominal wall incisional hernia (2024 edition)

CHEN Shuang(), ZHOU Taicheng   

  1. Department of Hernia and Abdominal Wall Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangzhou Zhongliu Biomedical Innovation Center, Guangdong Guangzhou 510655, China
  • Received:2026-01-08 Online:2026-02-25 Published:2026-04-21

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摘要：

2025年初发布的《腹壁切口疝诊疗指南（2024版）》首次系统引入 “转化治疗”“立体缝合”技术、“复杂腹壁状态”等核心观念与技术。在术前准备方面，2024版指南创新性提出以肉毒毒素注射联合渐进性人工气腹为核心的转化治疗策略。通过术前增加腹腔容积和腹壁顺应性，将原本高风险甚至禁忌的巨大切口疝病人转化为可手术状态，显著降低腹腔间室综合征及术后并发症风险。在手术技术层面，首次将腹腔镜“立体缝合”纳入规范化操作，强调关闭缺损、重建腹壁解剖连续性，推动切口疝修补从传统桥接修补向功能性重建转变。指南还系统界定了“复杂腹壁状态”的多维风险因素，强调多学科协作和个体化术式选择的重要性。同时，对腹壁功能不全(LOD)的评估提出以阈值为基础、结合腹壁顺应性与动态影像的综合判断模式。总体而言，新版指南以腹壁功能重建为核心，构建了更精细、更安全、更符合生物力学原则的切口疝诊疗体系，为复杂和巨大切口疝的规范化治疗提供了重要指导，也为未来循证研究和技术创新指明了方向。

关键词: 切口疝, 诊疗指南, 解读

Abstract:

Published in early 2025, the guidelines for the diagnosis and treatment of abdominal wall incisional hernia (2024 edition) has systematically introduced key concepts and technologies, including "conversion therapy" "three-dimensional suture" technique, and "complex abdominal wall status", for the first time. In terms of preoperative preparation, the 2024 edition innovatively proposed a conversion therapy strategy centered on botulinum toxin injection combined with progressive pneumoperitoneum. By increasing abdominal cavity volume and abdominal wall compliance preoperatively, this strategy converts patients with large incisional hernias who were originally high-risk or even contraindicated into operable candidates, significantly reducing the risks of abdominal compartment syndrome and postoperative complications. At the surgical technical level, laparoscopic "three-dimensional suture" has been incorporated into standardized procedures for the first time. The guideline emphasized defect closure and reconstruction of abdominal wall anatomical continuity, promoting a shift from traditional bridging repair to functional reconstruction in incisional hernia repair. Additionally, the guideline systematically defined the multidimensional risk factors of "complex abdominal wall status", highlighting the importance of multidisciplinary team and individualized surgical approach selection. It also proposed a threshold-based comprehensive assessment model for LOD (loss of domain), integrating abdominal wall compliance and dynamic imaging. Overall, with abdominal wall functional reconstruction as the core, the new edition established a more refined, safer, and biomechanically sound diagnostic and therapeutic system for incisional hernia. It provided important guidance for the standardized treatment of complex and large incisional hernias, and pointed out directions for future evidence-based research and technological innovation.

Key words: Incisional hernia, Diagnosis and treatment guideline, Interpretation

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