杂交技术切口疝修补术中应用生物补片的效果观察——单中心5年随访结果分析  

Observation of the efficacy of biological patch in hybrid technique for incisional herniorrhaphy： 5-year follow-up results from a single center

作　　者：戴伟钢[1] 袁玉杰[1] 左继东[1] 谭进富[1] 冯伟东[1] 袁凯涛[1] 赵琼云 谭敏[1] Dai Weigang;Yuan Yujie;Zuo Jidong;Tan Jinfu;Feng Weidong;Yuan Kaitao;Zhao Qiongyun;Tan Min(Department of Gastrointestinal Surgery, Hernia and Abdominal Wall Surgery, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China)

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

出　　处：《中华胃肠外科杂志》2018年第7期766-771,共6页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金.青年基金资助项目（81602660,81401307）;广东省公益研究和能力建设专项资金资助项目（2016A010103038）

摘　　要：目的探讨生物补片在杂交技术切口疝修补术中的安全性和有效性。方法回顾性分析2012年1月1日至2016年6月31日在中山大学附属第一医院应用生物补片做杂交技术切口疝修补术（即开腹联合腹腔镜辅助下的切口疝修补术）的14例患者临床和随访资料。术中采用生物补片为美国Cook公司生产的Biodesign Surgisis切口疝补片（猪小肠黏膜下层脱细胞基质补片），补片大小9 cm × 15 cm-20 cm × 25 cm，术中根据所需大小进行必要的修剪，确保补片覆盖缺损边缘超过5 cm。结果14例患者中男性4例，女性10例；年龄（67.7±11.6）岁，体质指数（25.5±1.7）kg/m2。腹部手术史：行胃肠肿瘤手术7例，阑尾手术2例，上腹部白线疝修补术1例，子宫切除术1例，胆囊切除术1例，脾切除术加门脉断流术1例，右肾、右侧输尿管全切除加膀胱壁部分切除术1例。腹部手术后出现切口感染10例。本次切口疝发生病程为1-180（中位数8）个月。2例难复性疝，1例嵌顿性疝，其余11例为可复性疝；切口疝发生位置：右侧腹壁4例、左侧腹壁1例、脐上正中切口2例、脐下正中切口4例、脐周正中3例。中切口疝3例，大切口疝5例，巨大切口疝6例。全组患者均顺利完成手术，手术时间120-390（202.5±72.9）min，术中测量疝环缺损的长径为（10.9±4.3）cm，短径为（9.3±3.9）cm。清洁手术11例，潜在污染手术2例，污染手术1例。术中出血量（15.0±4.8）ml。术后24 h疼痛数字评分法（NRS）疼痛评分为5.1±0.9，术后第3天为4.2±0.7，术后第7天为3.7±0.9；术后早期首次肛门排气时间为（2.5±0.9）d，早期进流质饮食时间（3.8±1.2）d。全组无围手术期死亡病例，住院时间（21.5±12.0）d；8例患者术后发生并发症，其中术后发热（≥38.5℃）4例，腹腔感染4例，术后伤口并发症8例；术后肠梗阻4例，术后补片下积液5例，肺部感染2�Objective To observe the safety and efficacy of biological patch （Biodesign Surgisis mesh, SIS） in hybrid technique for incisional herniorrhaphy. Methods Clinical and follow-up data of 14 incisional hernia patients who underwent incisional herniorrhaphy with hybrid technique, using porcine small intestinal submucosa acellular matrix patch, at the First Affiliated Hospital of Sun Yat-sen University from January 1, 2012 to June 31, 2016 were analyzed retrospectively. This Biodesign Surgisis patch for incisional hernia is produced by the Cook company in the United States. The size of patch ranged from 9 cm × 15 cm to 20 cm × 25 cm. During operation, according to abdominal wall defect, the patch was cut to ensure the distance from its edge to the border of abdominal wall defect more than 5 cm. Results There were four male and tenfemale patients with average age of （67.7±11.6） years and average body mass index（BMI） of （25.5±1.7） kg/m2. As for operative history of these 14 cases, 7 cases had gastrointestinal tumor surgery, 2 had appendectomy, 1 had upper abdominal white line hernia repair, 1 had hysterectomy, 1 had cholecystectomy, 1 had splenectomy plus portal vein dissection, and 1 had right kidney and right ureter total resection plus partial excision of bladder wall. Ten casesdeveloped incisional infection after previous surgery. The duration of incisional hernia ranged 1 to 180 months （median, 8 months）. Two cases were refractory hernia, 1 was incarcerated hernia, and 11 were reversible hernia. The locations of incisional hernia included 4 cases of right ventral wall, 1 case of left ventral wall, 2 cases of supra-umbilical incision, 4 cases of infra- umbilical midline incision, and 3 cases of peri-umbilical midline incision. There were 3 cases of middle incisional hernia, 5 cases of large incisional hernia and 6 cases of huge incisional hernia. All the patients completed operations eventlessly. The average operative time was （202.5±72.9） minutes. The average length and width of hernia

关 键 词：生物补片 切口疝 杂交技术 疝修补术 并发症 疗效 

分 类 号：R656.2[医药卫生—外科学]