腹腔镜与开放性腹壁切口疝修补术的疗效对比(1)
[摘要]目的 比较腹壁切口疝患者行腹腔镜腹壁切口疝修补术与开放性腹壁切口疝修补术的疗效。方法 回顾性分析2011年2月～2016年1月在我院接受腹壁切口疝手术治疗的61例患者的临床资料，按手术入路分为腹腔镜组(30例)与开放组(31例)。比较两组患者的术中出血量、手术时间、使用引流管率、术后疼痛(止痛药使用时间)、排气时间、术后并发症发生率、术后住院时间及慢性疼痛率和复发率。结果 腹腔镜组患者的术中出血量少于开放组，使用引流管率低于开放组，术后住院时间短于开放组，差异有统计学意义(P<0.01)。两组患者的手术时间、术后疼痛、排气时间、术后并发症总发生率、慢性疼痛率及复发率比较，差异无统计学意义(P>0.05)。结论 腹腔镜腹壁切口疝修补术疗效与开放性手术相同，但具有手术创伤小、术后住院时间短的优点。
[关键词]腹腔镜;腹壁切口疝;疝修补术
[中图分类号] R656.2 [文献标识码] A [文章编号] 1674-4721(2019)3(c)-0047-04
[Abstract] Objective To compare the efficacy of laparoscopic and open incisional hernia repair in patients with abdominal incisional hernia. Methods The clinical data of 61 patients who underwent abdominal incisional hernia surgery in our hospital from February 2011 to January 2016 were retrospectively analyzed. They were divided into the laparoscopic group (30 cases) and the open group (31 cases) according to the surgical approach. The intraoperative bleeding volume， the operation time， the rate of using drainage tube， the postoperative pain (the duration of analgesics use)， the first flatus time， the incidence of postoperative complication， the length of postoperative hospital stay， the chronic pain rate and the recurrence rate were compared between the two groups. Results The intraoperative bleeding volume in the laparoscopic group was less than that in the open group， and the rate of using drainage tube in the laparoscopic group was lower than that in the open group， and the length of postoperative hospital stay in the laparoscopic group was shorter than that in the open group， the differences were statistically significant (P<0.01). However， there were no significant differences in the operation time， the postoperative pain， the first flatus time， the total incidence rate of postoperative complication， the chronic pain rate and the recurrence rate between the two groups (P>0.05). Conclusion The laparoscopic abdominal incisional hernia repair has the same effect as the open operation， but it has the advantages of minimal invasion and shorter postoperative hospital stay.
[Key words] Laparoscope; Incisional hernia; Hernia repair
腹壁切口疝是腹部手術后常见的医源性并发症之一，发病率为3%～29%[1]。切口疝一旦发生，不能自愈，均需积极治疗，主要的手术治疗方法为单纯缝合修补和使用材料的加强修补，后者可以通过开放或腹腔镜进行。目前认为采用补片修补具有明显的优势，可作为首选[2]。本研究回顾性分析了在我院接受腹壁切口疝手术治疗的61例患者的临床资料，旨在比较腹壁切口疝患者行腹腔镜腹壁切口疝修补术与开放性腹壁切口疝修补术的疗效，以期为临床工作提供参考，现报道如下。
1资料与方法
1.1一般资料
回顾性分析2011年2月～2016年1月在我院普外科住院接受手术治疗的61例腹壁切口疝患者的临床资料，根据手术是否为腹腔镜手术或开放性手术将其分为腹腔镜组(30例)和开放组(31例)。腹腔镜组中，男12例，女18例;年龄27～82岁，平均(59.47±11.85)岁;体重指数(body mass index，BMI)19.56～33.29 kg/m2，平均(25.76±3.06)kg/m2;腹壁缺损最大径2.50～20.00 cm，平均(7.27±4.67)cm;其中中线切口疝16例，侧腹壁切口疝14例;美国麻醉医师协会(American Society of Anesthesiologists，ASA)麻醉风险分级：Ⅰ级9例，Ⅱ级17例，Ⅲ级4例;所有患者手术方式均为腹腔内网片植入术(intraperitoneal mesh placement，IPOM)。开放组中，男13例，女18例;年龄36～87岁，平均(62.45±12.07)岁;BMI 18.36～33.90 kg/m2，平均(24.33±3.65)kg/m2;腹壁缺损最大径1.50～25.00 cm，平均(8.40±5.78)cm;其中中线切口疝19例，侧腹壁切口疝12例;ASA分级：Ⅰ级5例，Ⅱ级16例，Ⅲ级10例;IPOM术18例，腹壁肌肉前放置(Onlay)2例，腹壁肌肉后(或腹膜前间隙)(Sublay)放置网片修补术11例。两组患者的一般资料比较，差异无统计学意义(P>0.05)，具有可比性。纳入标准：所有患者经影像学检查如彩超、CT等辅助检查确诊为腹壁切口疝，符合腹壁切口疝的诊断标准[2-3]。排除标准：因切口疝嵌顿行急诊手术、存在严重手术禁忌证者。本研究经医院医学伦理委员会批准。, 百拇医药(董令仪 黄坤寨 江翰)
[关键词]腹腔镜;腹壁切口疝;疝修补术
[中图分类号] R656.2 [文献标识码] A [文章编号] 1674-4721(2019)3(c)-0047-04
[Abstract] Objective To compare the efficacy of laparoscopic and open incisional hernia repair in patients with abdominal incisional hernia. Methods The clinical data of 61 patients who underwent abdominal incisional hernia surgery in our hospital from February 2011 to January 2016 were retrospectively analyzed. They were divided into the laparoscopic group (30 cases) and the open group (31 cases) according to the surgical approach. The intraoperative bleeding volume， the operation time， the rate of using drainage tube， the postoperative pain (the duration of analgesics use)， the first flatus time， the incidence of postoperative complication， the length of postoperative hospital stay， the chronic pain rate and the recurrence rate were compared between the two groups. Results The intraoperative bleeding volume in the laparoscopic group was less than that in the open group， and the rate of using drainage tube in the laparoscopic group was lower than that in the open group， and the length of postoperative hospital stay in the laparoscopic group was shorter than that in the open group， the differences were statistically significant (P<0.01). However， there were no significant differences in the operation time， the postoperative pain， the first flatus time， the total incidence rate of postoperative complication， the chronic pain rate and the recurrence rate between the two groups (P>0.05). Conclusion The laparoscopic abdominal incisional hernia repair has the same effect as the open operation， but it has the advantages of minimal invasion and shorter postoperative hospital stay.
[Key words] Laparoscope; Incisional hernia; Hernia repair
腹壁切口疝是腹部手術后常见的医源性并发症之一，发病率为3%～29%[1]。切口疝一旦发生，不能自愈，均需积极治疗，主要的手术治疗方法为单纯缝合修补和使用材料的加强修补，后者可以通过开放或腹腔镜进行。目前认为采用补片修补具有明显的优势，可作为首选[2]。本研究回顾性分析了在我院接受腹壁切口疝手术治疗的61例患者的临床资料，旨在比较腹壁切口疝患者行腹腔镜腹壁切口疝修补术与开放性腹壁切口疝修补术的疗效，以期为临床工作提供参考，现报道如下。
1资料与方法
1.1一般资料
回顾性分析2011年2月～2016年1月在我院普外科住院接受手术治疗的61例腹壁切口疝患者的临床资料，根据手术是否为腹腔镜手术或开放性手术将其分为腹腔镜组(30例)和开放组(31例)。腹腔镜组中，男12例，女18例;年龄27～82岁，平均(59.47±11.85)岁;体重指数(body mass index，BMI)19.56～33.29 kg/m2，平均(25.76±3.06)kg/m2;腹壁缺损最大径2.50～20.00 cm，平均(7.27±4.67)cm;其中中线切口疝16例，侧腹壁切口疝14例;美国麻醉医师协会(American Society of Anesthesiologists，ASA)麻醉风险分级：Ⅰ级9例，Ⅱ级17例，Ⅲ级4例;所有患者手术方式均为腹腔内网片植入术(intraperitoneal mesh placement，IPOM)。开放组中，男13例，女18例;年龄36～87岁，平均(62.45±12.07)岁;BMI 18.36～33.90 kg/m2，平均(24.33±3.65)kg/m2;腹壁缺损最大径1.50～25.00 cm，平均(8.40±5.78)cm;其中中线切口疝19例，侧腹壁切口疝12例;ASA分级：Ⅰ级5例，Ⅱ级16例，Ⅲ级10例;IPOM术18例，腹壁肌肉前放置(Onlay)2例，腹壁肌肉后(或腹膜前间隙)(Sublay)放置网片修补术11例。两组患者的一般资料比较，差异无统计学意义(P>0.05)，具有可比性。纳入标准：所有患者经影像学检查如彩超、CT等辅助检查确诊为腹壁切口疝，符合腹壁切口疝的诊断标准[2-3]。排除标准：因切口疝嵌顿行急诊手术、存在严重手术禁忌证者。本研究经医院医学伦理委员会批准。, 百拇医药(董令仪 黄坤寨 江翰)