腹腔镜与开放式无张力修补术治疗腹壁疝临床对比研究  

Clinical control study of laparoscopic procedures vs open mesh repair for ventral hernias

作　　者：李健文[1] 解轶声[1] 邱明远[1] 郑民华[1] 王春生[1] 王明亮[1] 陆爱国[1] 胡伟国[1] 毛志海[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院普外科上海市微创外科临床医学中心,上海200025

出　　处：《中国实用外科杂志》2008年第12期1040-1043,共4页Chinese Journal of Practical Surgery

摘　　要：目的评价腹腔镜腹壁疝修补术(LVHR)的安全性与有效性。方法对2007年1月至2008年8月间上海交通大学医学院附属瑞金医院接受无张力修补术的68例腹壁疝病人(缺损长径≤20cm)的临床资料进行回顾性分析。结果LVHR31例,开放式腹壁疝修补术(OVHR)37例。随访时间1～21个月(中位时间11个月)。LVHR与OVHR在年龄、性别比、BMI和疝缺损大小上差异无统计学意义(P>0.05)。LVHR与OVHR的平均手术时间分别为(60.5±17.7)min和(75.5±30.3)min(P=0.017),平均术后住院天数分别为(6.2±2.5)d和(9.6±8.0)d(P=0.026),术后2周内恢复非限制性活动人数分别为96.8%和78.4%(P=0.026),差异均有统计学意义。两组术后第1天的疼痛评分VAS分别为5.6±1.2和6.3±1.3,差异有统计学意义(P=0.018),术后1周和1个月的VAS差异无统计学意义(P=0.932,P=0.056)。两组总并发症发生率分别为19.4%和24.3%(P=0.623),复发率分别为3.2%和5.6%(P=1.000),差异无统计学意义。两组的住院总费用分别为(18334±5336)元和(9508±9222)元,差异有统计学意义(P=0.000)。结论LVHR对于缺损长径<20cm的腹壁疝是安全有效的。Objective To estimate the laparoscopic ventral hernia repair（LVHR）, focusing on the safety and efficiency of the operations. Methods The clinical data of 68 patients with ventral hernias （defect≤20cm） performed hernia reparing between January 2007 and August 2008 at Ruijin Hospital of Shanghai Jiao Tong University were analyzed retrospectively. Results Thirty-one patients underwent laparoscopic repair （LVHR）, and 37 patients underwent open mesh repair （OVHR）. The clinical outcome was determined by a median follow-up of 11 months（1-21 months） for the two groups. No significant differences were noticed between the two groups in age, sex, body mass index （BMI）, and hernia size. The mean operative time was （60.5±17.7）min for LVHR patients and （75.5±30.3）min for OVHR patients （P = 0.017）. The mean postoperative hospital stay was （6.2±2.5）d for LVHR patients and （9.6±8.0）d for OVHR patients （P = 0.026）. 96.8% of patients （30/31） were able to return to usual activity in 2 weeks for LVHR and 78.4% of patients （29/ 37） for OVHR （P=0.026）. LVHR patients felt less pain in the first day after operation （P= 0.018）, and there were no significant differences in visual-analogue pain scores between the two groups afterward. Complications occurred in 19.4 % of LVHR patients and 24.3 % of OVHR patients （P =0.623） with a recurrence rate of 3.2% in LVHR and 5.6% in OVHR patiems （P =1.000）. The mean cost was （18334±5336） yuan RMB for LVHR patients and （9508±9222） yuan RMB for OVHR patients （P=0.000）. Conclusion The short-term results indicate that laparoscopic technique is safe and effective for ventral hernia repairing with hernia defect less than 20cm.

关 键 词：腹壁疝 腹腔镜 疝修补术 

分 类 号：R6[医药卫生—外科学]