Abstract: Surgical managementof incisional ventral hernia has always been a bottle neck which is associated with considerable postoperative morbidity， risk of hernia recurrence. If there is no good preoperative preparation before the operation， the abdominal hypertension and abdominal hypertension syndrome （ACS） are very difficult to deal with. The treatment of giant incisional ventral hernia mainly relies on patch material to strengthen， and preoperative dilatation and reduction of abdominal wall tension serve as the adjuvant perioperative management. Despite advances in endoscopic techniques， materials and related basic research， giant incisional ventral hernia wall still faces high complications and recurrence rates.Botulinum toxin A （BTA） is a neurotoxic protein produced by Clostridium botulinum. Studies have shown that preoperative paralysis of the lateral abdominal muscles from intramuscular administration of BTA reduces the intraabdominal pressure， allowing closure of a hernia defect under less muscular tension. Ideally， temporary paralysis of the abdominal wall muscles with BTA prior to hernia repair may allow primary fascial closure without the need for component separation technique. The author has the experience of application of BTA in complex abdominal wall defect. This article reviews the progress of BTA in the incisional ventral hernia.

Key words: Botulinum toxin A, giant incisional ventral hernia, hernia repair, abdominal hypertension syndrome

摘要： ［摘要］ 腹壁巨大切口疝的治疗一直都是外科医生的瓶颈，若术前没有良好的准备，手术将疝内容物贸然还纳腹腔后可能引起病人膈肌抬高，腹内压力迅速升高，导致腹腔高压和腹腔间隔室综合症（ACS），处理起来非常棘手。腹壁巨大切口疝的治疗主要依靠补片材料加强修补，以及术前扩容、减弱腹壁张力等围手术期处理。尽管腔镜技术、材料学以及相关基础研究的进步，腹壁巨大切口疝仍面临高并发症和高复发率。肉毒杆菌毒素A（BAT）是近年来用于术前准备的治疗腹壁巨大切口疝的一种辅助方法，主要作用是降低腹壁肌肉横向张力、缩小腹壁缺损，使关闭腹腔更容易和安全。笔者科室已逐步开展BTA在复杂腹壁缺损治疗中的应用，现结合国外文献报道及自身使用经验，对BTA的应用进展作一综述。

关键词: 腹腔间隔室综合征, 巨大切口疝, 疝修补术, A型肉毒毒素