偶在癌肿手术时,需要切除被癌肿侵犯的全层腹膜和肌肉,直接复盖网片以修补缺损,网片直接接触肠曲,易导致肠瘘的发生.在1977～1986年,曾直接用网片复盖缺损32例,其中6例的缺损区位于后胁或上腹部,该处网片不直接接触肠曲,在余下的26例(网片直接接触肠曲)中,发生肠瘘6例,分别在术后3周、3月、5月、12月、15岁和13年.需取出网片,切除肠段.在1987～1992年,用网片修复腹壁缺损30例,但在网片和肠壁之间衬以大网膜、对侧的游离腹直肌或腹膜,未发生肠瘘,4例用腹膜移植者因肿瘤复发,2例曾再行探查,发现网片下层无致密粘连,深层的腹膜完整良好,所用网片均由聚丙稀制成,缝合时用尼龙线固定.为了阐明防止肠瘘的机制,作动物实验观察,取28只兔随机分为两组,在腹壁中部制成5×7cm肌腱膜缺损,13只兔用聚丙烯网片修补;另15只兔在网片下层加用一片游离腹膜,使网片下层无腹膜缺损,在1～3月后再次探查以观察网片下层的粘连情况.在28只兔中,1只伴腹膜移植和2只未用腹膜移的兔死亡.在14只用腹膜移植的兔中,未见致密粘膜,网片深层组织发亮,有小动脉长入,移植的腹膜与邻近的完整腹膜相似.而在11只未用腹膜移植兔中,10只兔的网片下层有致密粘连,并涉及深层的小肠(P=0.0001).可见在网膜下层衬以腹膜组织可以防止粘连和肠瘘的发 Even during cancer surgery, it is necessary to remove the full layer of peritoneum and muscles that are invaded by cancer and directly cover the mesh to repair the defect. The mesh directly touches the intestine, which can easily lead to intestinal fistula. From 1977 to 1986, 32 cases were directly covered with mesh, and the defect area of ​​6 cases was located in the posterior threat or upper abdomen. The mesh did not directly touch the bowel, and in the remaining 26 cases (mesh directly touching the bowel), the intestine developed. Six cases were found in 3 cases, 3 weeks, 3 months, 5 months, 12 months, 15 years and 13 years after operation. The mesh was removed and the intestine was removed. In 1987 to 1992, 30 cases of abdominal wall defects were repaired with mesh. However, in the lining between the mesh and the intestinal wall with a large omentum, the contralateral free rectus muscle or peritoneum, intestinal fistula did not occur, 4 cases of peritoneal transplantation due to tumor recurrence, 2 cases were re-explored and found mesh The lower layer had no dense adhesion, and the deep peritoneum was intact. The meshes used were all made of polypropylene. The sutures were fixed with nylon thread. To clarify the mechanism of the prevention of intestinal fistula, animal experiments were performed and 28 rabbits were randomly divided into two groups. A 5×7cm tendon membrane defect was made in the middle of the abdominal wall, and 13 rabbits were repaired with polypropylene mesh; the other 15 rabbits were given a piece of free peritoneum under the mesh to make the mesh lower layer. No peritoneal defect was detected again after 1 to 3 months to observe the adhesion of the lower mesh layer. Among 28 rabbits, 1 rabbit died with peritoneal transplantation and 2 rabbits did not use peritoneum, and 14 rabbits were transplanted with peritoneum. In rabbits, no dense mucous membranes were found, the deep tissue of the mesh was bright, and the small arteries grew in. The peritoneum was similar to the adjacent intact peritoneum. In the 11 rabbits without peritoneal transplantation, the lower layer of 10 rabbits had meshes. Dense adhesions, involving the deep small intestine (P=0.0001). Visible in the lower layer of the retina with peritoneal tissue to prevent adhesions and hairy bowel