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腹腔镜联合开腹补片修补术治疗腹壁切口疝的临床疗效

Clinical effects of laparoscopic combined with open mesh repair for abdominal wall incisional hernia
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摘要 目的:探讨腹腔镜联合开腹补片修补术治疗腹壁切口疝的临床疗效。方法:采用回顾性横断面研究方法。收集2011年9月至2017年6月福建医科大学附属协和医院收治的41例腹壁切口疝患者的临床资料。患者均行腹腔镜联合开腹补片修补术,手术顺序依次为:腹腔镜手术开腹手术腹腔镜手术。观察指标:(1)术中及术后情况。(2)随访情况。采用门诊和电话方式进行随访,了解患者术后远期并发症及疝复发情况。随访时间截至2017年11月。正态分布的计量资料以±s表示。结果:(1)术中及术后情况:41例患者均顺利完成腹腔镜联合开腹补片修补术。术中测量疝环直径为(10±3)cm,腹壁缺损面积为(75±34)cm2。41例患者中,25例因术中发现肠粘连紧密,腹腔镜分离肠粘连困难而行腹腔镜联合开腹补片修补术;16例因疝环直径大,腹腔镜下无法关闭疝环而行腹腔镜联合开腹补片修补术。41例患者手术时间为(188±71)min;其中33例术中留置引流管,术后引流管拔除时间为(14±3)d;术后住院时间为(4.5±2.6)d。41例患者中,术后不全性肠梗阻2例,对症处理后治愈;切口感染2例,予抗感染治疗、冲洗、换药后治愈。(2)随访情况:41例患者均获得术后随访,随访时间为(29±17)个月。41例患者中,术后慢性疼痛2例,均为偶发轻微疼痛,未影响正常生活;无血清肿、补片感染、肠瘘、腹腔间隔室合征发生。患者随访期间均未出现疝复发。结论:腹腔镜联合开腹补片修补术对于巨大切口疝及肠粘连紧密的腹壁切口疝患者具有较好的临床疗效,临床应用中应根据患者的病情选择合理的手术方式。 Objective:To explore the clinical effects of laparoscopic combined with open mesh repair for abdominal wall incisional hernia. Methods:The retrospective cross-sectional study was conducted. The clinical data of 41 patients with abdominal incisional hernia who were admitted to the Fujian Medical University Union Hospital between September 2011 and June 2017 were collected. All the patients underwent laparoscopic combined with open mesh repair, with the sequence from laparoscopic surgery to open surgery and then to laparoscopic surgery. Observation indicators: (1) Intra-and post-operative situations; (2) follow-up situation. follow-up using outpatient examination and telephone interview was performed to detect post-operative longterm complications and hernia recurrence up to November 2017. Measurement data with normal distribution were represented as ±s. Results: (1) Intra-and post-operative situations: fortyone patients underwent successful laparoscopic combined with open mesh repair for abdominal wall incisional hernia. Diameter of hernia ring and defect area of abdominal wall were respectively (10±3)cm and (75±34)cm2. Among 41 patients, 25 underwent laparoscopic combined with open mesh repair due to tight intestinal adhesion induced difficult laparoscopic separation; 16 underwent laparoscopic combined with open mesh repair due to the larger diameter of the hernia ring induced difficulty of closing hernia ring under laparoscope. Operation time, cases with indwelling drainage-tube, time of drainage-tube removal and duration of post-operative hospital stay were respectively (188±71)minutes, 33, (14±3)days and (4.5±2.6)days. Of 41 patients, 2 with post-operative incomplete intestinal obstruction were cured by symptomatic treatment; 2 with incisional infection were cured by antibiotic therapy, irrigation and dressing change. (2) follow-up situation: 41 patients were followed up for (29±17)months. The post-operative chronic pain of 2 patients was occasional an
作者 戴晓冬 黄鹤光 陈燕昌 陆逢春 林贤超 林荣贵 杨媛媛 王丛菲 Dai Xiaodong, Huang Heguang, Chen Yanchang, Lu Fengchun, Lin Xianchao, Lin Ronggui, Yang Yuanyuan, Wang Congfei( Department of General Surgery, Fufian Medical University Union Hospital, Fuzhou 350001, China)
出处 《中华消化外科杂志》 CSCD 北大核心 2018年第11期1090-1094,共5页 Chinese Journal of Digestive Surgery
基金 福建省微创医学中心项目(闽卫医政函[2017]171) 福建省医学临床重点专科建设项目(闽财指[2012]649)
关键词 腹壁切口疝 疝修补术 补片修补术 聚丙烯补片 肠粘连 巨大切口疝 复发 并发症 腹腔镜检查 Incisional hernia abdominal wall Hernia repair Mesh repair Polypropylene mesh Intestinal adhesion Incisional hernia giant Recurrence Complications Laparos-copy
作者简介 通信作者:黄鹤光.Email:Heguanghuang2@163.com.
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