复发性腹壁切口疝腹腔镜修补和Onlay修补治疗的对比研究

发布时间：2018-09-19 14:13

【摘要】：目的:通过探讨两种手术方式治疗复发性腹壁切口疝的临床效果,证实腹腔镜修补复发性腹壁切口疝的安全性及可行性。方法:回顾性总结2006年06月至2016年12月收治的102例复发性腹壁切口疝患者的临床资料,其中Onlay修补法(肌鞘前的修补)56例,腹腔镜修补法46例,比较分析两组手术时间、术后下地时间、术后住院时间、术后疼痛、术后并发症、住院费用及复发率。结果:腹腔镜修补组的手术时间、住院费用高于Onlay修补组,差异有统计学意义(P0.05);Onlay修补组术后血清肿7例,切口感染5例,肠管损伤4例,术后疼痛4例,不全性肠梗阻各3例,并发症共计23例(41.07%)。腹腔镜修补组术后血清肿2例,切口感染2例,肠管损伤5例,术后疼痛1例,不全性肠梗阻2例,并发症共计12例(19.57%)。两组患者并发症经对症治疗后均好转,未发生补片感染,慢性疼痛,肠瘘等。两组比较,腹腔镜修补组并发症的发生率低于Onlay修补组(P0.05),术后住院时间、下床活动时间短于Onlay修补组,差异有统计学意义(P0.05)。结论:腹腔镜修补术治疗复发性腹壁切口疝具有术后下地时间早、术后住院时间短、术后并发症少等优点,但住院费用高、手术时间长,两者术后复发率相近。两种手术方式治疗复发性腹壁切口疝均为安全、有效的。两者手术方式如何选择应根据患者实际情况及外科医生的技术、经验决定。
[Abstract]:Objective: to investigate the safety and feasibility of laparoscopic repair of recurrent abdominal incisional hernia. Methods: the clinical data of 102 patients with recurrent abdominal wall incisional hernia from June 2006 to December 2016 were retrospectively reviewed, including 56 cases with Onlay repair (anterior muscle sheath repair) and 46 cases with laparoscopic repair. The operative time of the two groups was compared and analyzed. Postoperative floor time, postoperative hospitalization time, postoperative pain, postoperative complications, hospital expenses and recurrence rate. Results: the operative time and hospitalization cost of laparoscopic repair group were significantly higher than that of Onlay repair group. The difference was statistically significant (P0.05). There were 7 cases of postoperative serum swelling, 5 cases of incision infection, 4 cases of intestinal injury, 4 cases of postoperative pain and 3 cases of incomplete intestinal obstruction in the laparoscopic repair group. A total of 23 cases (41.07%) had complications. In the laparoscopic repair group, there were 2 cases of serum swelling, 2 cases of incisional infection, 5 cases of intestinal injury, 1 case of postoperative pain, 2 cases of incomplete intestinal obstruction, and 12 cases (19.57%) of complications. The complications of the two groups were improved after symptomatic treatment, no patch infection, chronic pain, intestinal fistula and so on. The incidence of complications in the laparoscopic repair group was lower than that in the Onlay repair group (P0.05). The postoperative hospitalization time and the time to get out of bed were shorter than those in the Onlay repair group (P0.05). Conclusion: laparoscopic repair for recurrent abdominal incisional hernia has the advantages of early operation time, short hospitalization time and less postoperative complications, but the cost of hospitalization is high, the operation time is long, and the recurrence rate of both is similar. Both surgical methods are safe and effective in the treatment of recurrent abdominal incisional hernia. The choice of the two surgical methods should be based on the actual situation of the patient and the surgeon's skill and experience.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R656.2

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