猪小肠黏膜下层脱细胞基质补片在腹股沟疝Lichtenstein修补术中应用疗效观察  

Efficacy of Lichtenstein inguinal hernia repair using porcine small intestinal submucosa mesh

作　　者：戴伟钢[1] 左继东[1] 谭进富[1] 袁玉杰[1] 冯伟东[1] 袁凯涛[1] 赵琼云 谭敏[1] 

机构地区：[1]中山大学附属第一医院胃肠外科疝与腹壁外科,广东广州510080

出　　处：《中国实用外科杂志》2017年第11期1254-1257,共4页Chinese Journal of Practical Surgery

基　　金：广东省科技计划资助项目(No.2016A0103038);国家自然科学基金-青年基金资助项目(No.81602660)

摘　　要：目的探讨猪小肠黏膜下层(SIS)脱细胞基质补片(以下简称SIS补片)在腹股沟疝Lichtenstein修补术中应用的安全性、有效性以及术后疗效。方法回顾性分析2012-03-01—2015-10-31于中山大学附属第一医院行Lichtenstein疝修补术时使用SIS补片治疗的87例腹股沟疝病人临床资料。观察病人术后并发症发生情况和长期疗效。结果手术时间45~70(55.7±6.9)min。术后24 h疼痛视觉模拟评分(VAS)为0分者9例(10.3%),1~3分者71例(81.6%),4~6分者7例(8.0%)。术后发生血清肿2例(2.3%);4例(4.6%)出现伤口脂肪液化或感染,均未取出补片,通过换药和使用抗生素治疗后痊愈;3例(3.9%)病人出现阴囊轻度肿胀。术后共70例病人获得长期随访,随访率80.5%,术后随访时间36.0(22.5~66.0)个月。17例(24.3%)病人在运动时感觉轻微疼痛不适,无明显静息痛。10例(14.3%)病人在运动时出现腹股沟区不适感,静息时无不适感。10例(14.3%)病人存在腹股沟区麻木不适或感觉差异,持续6~12个月。3例(4.3%)病人自觉腹股沟区轻度异物感,持续6~12个月。1例(1.4%)疝复发。59例病人睾丸相关并发症和性功能随访资料显示,病人均未出现睾丸萎缩,无射精障碍或疼痛,性功能无影响。结论 Lichtenstein修补术中使用SIS补片安全有效,SIS补片术后疼痛不适感较轻,其长期疗效有待进一步观察。Objective To evaluate the safety and efficacy of Lichtenstein hernioplasty using porcine small intestinal submucosa mesh （SIS）. Methods The clinical data of 87 patients with inguinal hernia who underwent Lichtenstein hernia repair with SIS mesh from March 1, 2012 to October 31, 2015 in the First Affiliated Hospital of Sun Yat-sen University were analyzed retrospectively. The postoperative complications of the patients were analyzed and the long-term effects were observed. Results The mean operation time was （55.7＋-6.9） minutes （range 45 to 70 minutes）. The postoperative pain score of VAS in 24 hours was 0 points in 9 patients （10.3%）, 1 to 3 scores in 71 patients （81.6%）, 4 to 6 scores in 7 patients （8.0%）, respectively. Postoperative serum swelling was found in 2 patients （2.3%）. 4.6% （4/87） of patients showed fat liquefaction or infection in the wound, and all the patients did not remove the patches,who were cured after changing dressings and using antibiotics. Slight swelling of the scrotum occurred in 3 patients （3.9%）. A total of 70 patients were followed up for a long term of 36 （range 22.5 to 66.0） months. The follow-up rate was 80.5%. Seventeen patients （24.3%） felt mild pain during exercise and no obvious resting pain. Ten patients （14.3%） had groin discomfort during exercise, and there was no discomfort at rest. Ten patients （14.3%） had inguinal numbness or sensory differences lasting for 6 to 12 months. Three patients （4.3%） felt mild foreign sensation in the groin area and lasted for 6 to 12 months. One patient （t.4%） relapsed.The testicular complications and sexual function in 59 patients had been followed up. There were no testicular atrophy, no ejaculatory dysfunction or pain, and the sexual function did not decrease Compared with the preoperative condition. Conclusion SIS mesh used in Lichtenstein repair is safe and effective. It may be superior to synthetic patch in chronic pain, and long-term effect needs the further observation.

关 键 词：腹股沟疝 生物补片 复发 疝修补术 

分 类 号：R6[医药卫生—外科学]