轻量型和中量型补片用于腹股沟疝无张力修补术的疗效对比  

Retrospective comparison on therapeutic outcomes between light-weight mesh and middle-weight mesh used in open hernia repair

作　　者：裴国清[1] 杨帆[1] 倪晓春[1] 吴巨钢[1] 王守练[1] 姜波健[1] 俞继卫[1] 

机构地区：[1]上海交通大学医学院附属第九人民医院普外科,201999

出　　处：《中华疝和腹壁外科杂志（电子版）》2017年第1期4-9,共6页Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition)

摘　　要：目的比较开放式腹股沟疝无张力修补术中,轻量型补片和中量型补片的疗效、并发症发生率及舒适度。方法回顾性分析2011年1月至2014年1月,上海交通大学医学院附属第九人民医院行腹股沟疝无张力修补术的145例(152侧)患者临床资料,其随访率为91.19%。研究分为轻量型补片组59例(60侧)和中量型补片组86例(92侧)。于术后3、6及12个月行门诊和电话随访,对比分析2组患者手术前后的各观察指标。结果轻量型补片组和中量型补片组术后疝复发率分别为1.67%和1.09%(P=0.762)。在术后3个月和6个月,2组病例的疼痛发生率、疼痛程度、腹股沟区不适发生率、异物感发生率及边缘牵扯感发生率比较,差异均无统计学意义(P>0.05)。术后1年时,轻量型补片组和中量型补片组的疼痛发生率(8.51%vs 12.50%)、异物感发生率(4.26%vs12.50%)、VAS疼痛评分均值(0.24±0.02 vs 0.34±0.14)及边缘牵扯感(6.38%vs 5.35%)比较,差异均无统计学意义(P>0.05);但术后腹股沟区不适发生率比较,轻量型补片组为17.02%,显著优于中量型补片组的37.50%,差异有统计学意义(P=0.021)。结论轻量型补片在腹股沟疝无张力修补术的应用是安全有效的,1年期的随访结果显示轻量型补片组的腹股沟区不适发生率显著低于中量型补片组。相较于补片重量而言,网孔的大小或对术后慢性疼痛和腹股沟区异物感具有更重要的影响。Objective To compare the therapeutic benefits of light-weight mesh and middle-weight mesh used in open tension-free inguinal hernia repair. Methods A total of 145 cases/152 sides of inguinal hernia repair in Shanghai Ninth People＇ Hospital from January 2011 to January 2014 were retrospectively investigated. Two kinds of meshes were applied including light-weight mesh （LWM, 59 cases/60 sides） and middle-weight mesh （MWM, 86 cases/92 sides）. At 3 months, 6 months and 1 year after operation, all patients were assessed for chronic pain, foreign body sensation, mesh pulling feeling and groin discomfort by questionnaire and by clinical examinations. Results The recurrence rates in the LWM group and the MWM group were 1.67% and l. 09% , respectively （P = 0. 762）. At 3 months and 6 months after operation, no significant difference identified in the incidences of chronic pain, groin discomfort, mesh pulling feeling and foreign body sensations. At 1 year after operation, compared the LWM group and the MWM group, there were no significant differences in the VAS score, chronic pain rate （8.51% vs 12.50% ）, foreign body sensation （4. 26% vs 12. 50% ） and mesh pulling sensation （6. 38% vs 5. 35% ）. The incidence of discomfort in inguinal region in the light-weight mesh group was 17.02% , which was significantly lower than that in the middle-weight mesh group （ 37.50%, P = 0. 021 ）. Conclusion This study shows that the application of LWM is safe and effective in the open inguinal hernia repair, and LWM could significantly improve the incidence of discomfort in inguinal region at 1 year after operation. The pore size may have a more significant effect on postoperative chronic pain and foreign body sensation than mesh weight.

关 键 词：疝 腹股沟 疝修补术 手术后并发症 

分 类 号：R656.21[医药卫生—外科学]