猪小肠黏膜下层脱细胞基质补片与聚丙烯补片应用于前腹壁切口疝修补术的疗效分析  

Efficacy analysis of porcine small intestine submucosa-derived mesh and polypropylene mesh applied in anterior abdominal wall incisional hernia repair

作　　者：戴伟钢[1] 陈志辉[1] 谭进富[1] 袁玉杰[1] 左继东[1] 赵琼云 谭敏[1] Dai Weigang;Chen Zhihui;Tan Jinfu;Yuan Yujie;Zuo Jidong;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：《中华消化外科杂志》2018年第11期1095-1100,共6页Chinese Journal of Digestive Surgery

摘　　要：目的：探讨猪小肠黏膜下层脱细胞基质（SIS）补片和聚丙烯补片应用于前腹壁切口疝修补术的临床疗效。方法：采用回顾性队列研究方法。收集2012年1月至2017年12月中山大学附属第一医院收治的59例行前腹壁切口疝修补术患者的临床资料。59例患者中，22例采用SIS补片行前腹壁切口疝修补术，设为SIS组；37例采用聚丙烯补片行前腹壁切口疝修补术，设为PP组。术者依据患者疝环情况等选择手术方式。观察指标：（1）术中和术后恢复情况。（2）随访情况。采用门诊和电话方式进行随访，了解患者术后远期并发症发生情况，包括腹壁异物感或疼痛、疝复发。随访时间截至2018年5月。正态分布的计量资料以±s表示，组间比较采用t检验。偏态分布的计量资料以M（范围）表示，组间比较采用MannWhitney U检验。计数资料比较采用x2检验或Fisher确切概率法。结果：（1）术中和术后恢复情况：SIS组和PP组患者均顺利完成前腹壁切口疝修补术。SIS组患者采用开腹腹壁肌肉前补片修补术、开腹腹壁肌肉后补片修补术、腹腔镜腹膜腔内补片修补术、腹腔镜联合开腹补片修补术分别为2、3、3、14例，PP组分别为5、26、1、5例。SIS组患者术中出血量、术后切口血清肿例数、术后手术部位感染例数分别为（23± 11）mL、7例、5例，PP组分别为（30±13）mL、3例、1例，两组上述指标比较，差异均有统计学意义（t= -2.238，P〈0.05）。（2）随访情况：SIS组和PP组患者均获得术后随访，随访时间分别为29.3个月（6.0～66.0个月）和31.0个月（7.0～76.0个月），两组比较，差异无统计学意义（Z=-1.388，P〉0.05）。随访期间，SIS组患者腹壁异物感或疼痛、疝复发例数分别为6、6例，PP组分别为4、2例，两组上述指标比较，疝复发差异有统计学意义（P〈0.05），腹壁异物感或疼痛差异无统计学Objective：To investigate the clinical efficacy of porcine small intestine submucosa-derived （SIS） mesh and polypropylene （PP） mesh applied in anterior abdominal wall incisional hernia repair. Methods：The retrospective cohort study was conducted. The clinical data of 59 patients who underwent anterior abdominal wall incisional hernia repair in the First Affiliated Hospital of Sun Yat-Sen University between January 2012 and December 2017 were collected. Of 59 patients, 22 undergoing anterior abdominal wall incisional hernia repair with SIS mesh and 37 undergoing anterior abdominal wall incisional hernia repair with PP mesh were respectively allocated into the SIS group and PP group. Surgeons selected surgical procedures according to hernia ring situations of patients. Observation indicators： （1） intra and postoperative recovery situations; （2） follow-up. follow-up using outpatient examination and telephone interview was performed to detect longterm complications of patients including foreign body sensation or pain in abdominal wall and hernia recurrence up to May 2018. Measurement data with normal distribution were represented as ±s, and comparison between groups was done using t test. Measurement data with skewed distribution were described as M （range）, and comparison between groups was done using MannWhitney U test. Comparison of count data was analyzed using the chisquare test or Fisher exact probability. Results：（1） Intra and postoperative recovery situations： patients of the SIS group and PP group underwent successfully anterior abdominal wall incisional hernia repair. There were 2, 3, 3, 14 and 5, 26, 1, 5 patients undergoing open Onlay repair, open Sublay repair, laparoscopic intra-peritoneal onlay mesh repair, laparoscopic combined with open mesh repair in the SIS group and PP group respectively. The volume of intra-operative blood loss, cases of postoperative incisional seroma and surgical site infection were （23±11）mL, 7, 5 in the SIS group and （30±13）mL, 3, 1

关 键 词：腹壁切口疝 疝修补术 腹腔镜检查 生物补片 聚丙烯补片 并发症 复发 

分 类 号：R656.2[医药卫生—外科学]