腹腔镜腹壁切口疝修补术94例报告及文献回顾

发布时间：2019-05-24 19:16

【摘要】：背景腹壁切口疝是腹部手术后较常见的并发症。其不能自愈,且随着病程和年龄的增加有逐渐增大的趋势。因此,除有禁忌证者外,腹壁切口疝病人均需采取积极手术治疗。在腹腔镜腹壁切口疝修补术中,补片的地位无法取代。目前,补片的研究发展迅速,每种补片的优点、缺点、特性以及适用范围都在不断被了解、被发现、被认识。疝外科大夫应知道如何选择合适的补片。目的通过对使用不同补片进行腹壁切口疝手术病人治疗效果的分析及对比,结合相关文献综述,总结腹腔镜腹壁切口疝修补术中的补片选择及手术经验,为临床医师提供诊治经验,使其能更准确地选择合适补片治疗腹壁切口疝,从而获得更满意的治疗效果。方法回顾性分析2011年6月至2017年1月山东大学齐鲁医院行腹腔镜腹壁切口疝修补术的94例腹壁切口疝病人的临床资料,手术方式均为腹腔内网片修补法(intraperitoneal onlay mesh,IPOM),固定方式均为螺旋型缝钉钉合+缝线悬吊固定,根据不同补片进行分组,对手术时间、术中出血量、术后体温、抽血化验指标、术后胃肠道功能恢复时间、切口及戳孔感染、持续腹腔引流时间、总腹腔引流量、术后住院时间、医疗花费、血清肿、补片感染、肠痿、慢性疼痛和疝复发发生情况进行数据分析。结果文章共纳入94例腹壁切口疝病人,其中Composix E/X组28例,Parietex Composite组28例,Sepramesh组38例。3组病人的年龄、性别组成、体重、疝环大小均无统计学差异(P0.05),具有可比性。ComposixE/X组并发症总发生率、血清肿发生率均高于 Parietex Composite 组及 Sepramesh 组(P0.01),Parietex Composite组、Sepramesh组持续腹腔引流时间、总腹腔引流量、医疗花费则高于Composix E/X组(P0.01)。而在手术时间、术中出血量、术后体温、抽血化验指标、切口及戳孔感染发生率、术后住院时间、肠瘘发生率、补片感染、慢性疼痛和疝复发上无统计学差异(P0.05)。结论腹腔镜腹壁切口疝修补术(IPOM术式)是安全、有效的。与腹腔内置入补片相关的术后并发症包括血清肿、补片感染、肠痿、慢性疼痛等。补片的选择需综合考虑病人病情、经济负担能力及术者临床经验、手术技巧等因素。选择合适的补片可以获得更满意的治疗效果。对不同的病例宜采用个体化治疗方案。
[Abstract]:Background abdominal incisional hernia is a common complication after abdominal surgery. It can not heal itself, and it tends to increase gradually with the increase of course of disease and age. Therefore, in addition to contraindications, abdominal incisional hernia patients need to take active surgical treatment. In laparoscopic hernia repair with abdominal incision, the position of patch can not be replaced. At present, the research of patch is developing rapidly, and the advantages, disadvantages, characteristics and scope of application of each patch are constantly understood, discovered and recognized. Hernia surgeons should know how to choose the right patch. Objective to analyze and compare the therapeutic effects of different patches in the treatment of abdominal incisional hernia, and to summarize the patch selection and surgical experience in laparoscopic abdominal incisional hernia repair combined with the review of related literature. To provide clinicians with experience in diagnosis and treatment, so that they can more accurately select appropriate patches for the treatment of incisional hernia of abdominal wall, so as to obtain more satisfactory therapeutic effect. Methods the clinical data of 94 patients with abdominal incisional hernia treated by laparoscopy in Qilu Hospital of Shandong University from June 2011 to January 2017 were analyzed retrospectively. all of them were treated with intraabdominal mesh repair (intraperitoneal onlay mesh,IPOM). The fixation methods were spiral sutures and stitches suspended and fixed, which were divided into groups according to different patches. The operation time, intraoperative blood loss, postoperative body temperature, blood sampling test index, postoperative gastrointestinal function recovery time, incision and puncture hole infection were divided into two groups: operation time, intraoperative bleeding volume, postoperative body temperature, blood sampling test index, postoperative gastrointestinal function recovery time, incision and puncture hole infection. The data of continuous abdominal drainage, total abdominal drainage, postoperative hospital stay, medical expenses, serum swelling, patch infection, intestinal impotence, chronic pain and hernia recurrence were analyzed. Results there were 94 patients with incisional hernia of abdominal wall, including 28 patients in, Parietex Composite group and 38 patients in Sepramesh group, including 28 patients in, Parietex Composite group and 38 patients in Sepramesh group. There was no significant difference in age, sex composition, body weight and hernia ring size among the three groups (P 0.05). The total incidence of complications and serum swelling in ComposixE / X group were higher than those in Parietex Composite group and Sepramesh group (P 0.01), Parietex Composite group, Sepramesh group), and the total abdominal drainage rate was higher in ComposixE / X group than that in ComposixE / X group and ComposixE / X group. The cost of medical treatment was higher than that of Composix E 鈮，

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