三种手术方式治疗腹壁切口疝的临床疗效分析

发布时间：2018-05-10 08:59

本文选题：切口疝 + 疝修补术　；参考：《浙江大学》2017年硕士论文

【摘要】：背景腹壁切口疝是腹部外科术后常见的长期并发症之一,发生率在11-20%,切口疝一旦形成,保守治疗难以治愈,进展后还可能导致肠粘连及肠绞窄,甚至危及生命,手术治疗是唯一的有效手段。开放式修补是传统的手术方式,随着腹腔镜手术及修补材料的不断发展,腹腔镜切口疝修补术应用越来越普遍,近年一些专家还将腹腔镜技术与开放术式相结合,形成杂交技术(Hybrid Technique incisional hernia repair),大宗文献报道比较了各种术式的疗效,但结果差异性很大,哪种术式是才是最理想的手术方式目前仍存在争议。目的对比分析开放术式、杂交术式、腹腔镜术式三种手术方式治疗腹壁切口疝的临床疗效,为外科医生选择最理想的术式提供参考。方法回顾性分析浙江大学医学院附属邵逸夫医院2010年1月至2016年6月行腹壁切口疝修补术的86例患者的临床资料,其中OIHR组(开放组)28例,HTIHR组(杂交组)27例,LIHR组(腹腔镜组)31例,在排除年龄、性别、BMI、ASA分级、合并症等一般资料的差异性之后,对比三组术中术后的一些临床指标有无统计学意义,其中计量资料包括手术时间、术中出血、腹壁缺损大小、术后恢复进食时间、术后使用镇痛药次数、住院时间等,计数资料包括血清肿/浆液肿,切口感染,肺部感染,腹壁疼痛等相关并发症及复发情况。结果三组患者在一般资料、切口疝类型、术中出血、住院时间、并发症上无显著性差异。LIHR组较其他两组腹壁缺损面积小(P0.05),术后进食时间(即肠道恢复时间)短(P0.05),使用镇痛药次数少(P0.05),有统计学意义。较OIHR组手术时间短,但差异不显著。HTIHR组较LIHR组手术时间长(P0.05),有明显统计学差异。OIHR组复发率21.4%(6/28),LIHR组复发率3.2%(1/31),HTIHR组无复发病例,有显著统计学差异。结论腹腔镜腹壁切口疝修补术与杂交技术切口疝修补术均是安全有效的可替代传统开放术式的手术方式,腹腔镜术式较开放术式有损伤小、手术时间短、疼痛少、恢复快等优势。而对于较复杂较大的切口疝及复发疝,杂交技术将开放术式直视分离与腹腔镜术式直视固定补片的优势结合起来,从而提高了手术疗效、降低复发率。另外随着修补材料、固定材料、手术方式尤其是机器人手术、术后评估等技术的不断发展,腹腔切口疝的手术治疗将会取得越来越好的效果。
[Abstract]:Background incisional hernia of abdominal wall is one of the common long-term complications after abdominal surgery. The incidence of incisional hernia is 11-20. Once incisional hernia is formed, conservative treatment is difficult to cure. Surgical treatment is the only effective means. Open repair is a traditional surgical method. With the development of laparoscopic surgery and repair materials, laparoscopic incisional hernioplasty is becoming more and more common. In recent years, some experts have combined laparoscopic technique with open operation. Hybrid Technique incisional hernia repairn (hybrid Technique incisional hernia repairn) was formed. A large number of literature reports have compared the efficacy of various surgical procedures, but the results are very different, which is the most ideal operation method is still controversial. Objective to compare and analyze the clinical effects of open operation, hybrid operation and laparoscopic operation in the treatment of abdominal incisional hernia, and to provide a reference for surgeons to choose the most ideal operation. Methods the clinical data of 86 patients undergoing incisional herniorrhaphy of abdominal wall from January 2010 to June 2016 in run run run Shaw Hospital affiliated to Zhejiang University Medical College were retrospectively analyzed. Among them, OIHR group (open group, 28 cases with HTIHR) (hybridization group, 27 cases), LIHR group (LIHR group, 31 cases), after ruling out the difference of age, sex, BMIASA grade, complication and other general data, etc. There were significant differences in some clinical indexes between the three groups, including operative time, intraoperative bleeding, abdominal wall defect, postoperative recovery time, times of using analgesics after operation, hospitalization time and so on. Counting data included seroderma / seroderma, incision infection, pulmonary infection, abdominal wall pain and other related complications and recurrence. Results three groups of patients in general information, incisional hernia type, intraoperative bleeding, hospital stay, There was no significant difference in complications. The area of abdominal wall defect in the LIHR group was smaller than that in the other two groups. The feeding time (that is intestinal recovery time) after operation was shorter than that in the other two groups (P 0.05), and the number of times of using analgesics was less than that of the other two groups (P 0.05). The time of operation was shorter than that of OIHR group, but the difference was not significant. The operation time of HTIHR group was longer than that of LIHR group (P 0.05), there was significant difference. The recurrence rate of OIHR group was 21. 4% / 28% LIHR group, the recurrence rate was 3. 2% / 31% HTIHR group and there were no recurrence cases, there was significant statistical difference. Conclusion Laparoscopic incisional herniorrhaphy and hybrid herniorrhaphy are safe and effective alternative to traditional open hernia repair. Laparoscopy has less injury, shorter operation time and less pain than open operation. Recover advantages such as speed. For the more complex and larger incisional hernia and recurrent hernia, the hybrid technique combined the advantages of open open surgery with laparoscopic direct vision fixed patch to improve the curative effect and reduce the recurrence rate. In addition, with the development of repair materials, fixation materials, surgical methods, especially robotic surgery, postoperative evaluation and other technologies, surgical treatment of abdominal incisional hernia will achieve more and more good results.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R656.2

【相似文献】