不同大小补片修补腹股沟疝及切口疝后急性炎症反应的对比研究  

Contrastive analysis of acute inflammatory response to different size of polyprolene mesh after inguinal and incisional hernia repair

作　　者：李阳[1] 王世斌[1] 费阳[1] 

机构地区：[1]中国人民解放军总医院第一附属医院普通外科,北京100048

出　　处：《中国急救复苏与灾害医学杂志》2013年第7期629-631,共3页China Journal of Emergency Resuscitation and Disaster Medicine

摘　　要：目的研究以不同大小的聚丙烯补片行腹股沟疝及切口疝无张力修补术后的急性炎症反应程度。方法本组患者分为腹股沟疝组（I组，n=20）和切口疝组（Ⅱ组，n=20）；Ⅰ组分为传统手术组（Ⅰa组，以传统Bassini方法修补）和无张力手术组（Ⅰb组，用36cm2聚丙烯补片以Lichtenstein方法修补）；Ⅱ组分为传统手术组（Ⅱa组，行传统的缝合修补）和无张力手术组（Ⅱb组，用360cm。聚丙烯补片行Sub-lay修补）。分别于术前24h和术后6、24、48、168h采集外周静脉血标本检测白细胞（wBc）、C-反应蛋白（CRP）、IL-6等指标。结果所有亚组术后静脉血中的WBC计数以及CRP与IL-6水平均较术前明显升高；术后的Ⅰb组的上述指标水平高于术后的Ⅰa组，Ⅱb组高于Ⅱa组；不同组别之间的比较为Ⅰb组和Ⅱa组指标水平相近，而Ⅱb为最高、Ⅰa为最低。结论使用聚丙烯补片的无张力疝修补所引发的炎症反应要大于传统的缝合修补，而且补片大小也和炎症反应呈正相关。Objective To assess the acute inflammatory response after implantation of polypropylene mesh for tension-free inguinal and incisional hernia repair. Methods Forty patients in the study were divided into two groups. The first group affected by inguinal hernia was allocated either for conventional repair by Bassini method （subgroup Ⅰa） or for hernioplasty with 36 cm2 polypropylene mesh by Lichtenstein method （subgroup Ⅰb）, while the second group affected by incisional hernia was allocated either for conventional suture repair （subgroup Ⅱa） or for incisional hernia repair with 360 cm2 polypropylene mesh （subgroup Ⅱb）. Peripheral venous blood samples were collected 24 hours prior to the operation and 6, 24, 48, and 7 days after the operation to detect white blood cell count, level of C-reactive protein （CRP）, and interleukin-6 （IL-6）. Results Serum levels of leukocytes, CRP and IL-6 were significantly increased postoperatively in all subgroups compared with their preoperative values. In particular, these indexes in subgroups Ⅰb and Ⅱb were higher than those in subgroups Ⅰa and Ⅱa, respectively. Comparing the entities of the inflammatory responses among various subgroups, it was clear that they were similar in subgroups Ⅰb and Ⅱa, and that the highest were in subgroup Ⅱb and the lowest in subgroup Ⅰa. Conclusion The study demonstrates conventional inguinal and incisional hernia repair induces an inflammatory response, which is smaller than that observed if both operations are carried out with polypropylene meshes. Furthermore, the results suggest that a larger mesh be associated with a higher production of inflammation mediators.

关 键 词：白细胞介素-6 C-反应蛋白 补片 合成材料 疝 

分 类 号：R656.21[医药卫生—外科学]