DynaMesh—IPST造口专用补片在腹壁造瘘口旁疝修补术中的应用价值  

Application value of DynaMesh-IPST stoma dedicated mesh in parastomal hernia repair

作　　者：王帆[1] 靳翠红 申英末[1] 赵凤林[1] 朱熠林[1] 陈杰[1] Wang Fan;Jin Cuihong;Shen Yingmo;Zhao Fenglin;Zhu Yilin;Chen Jie(Department of Hernia and Abdominal Wall Sur-gery,Beijing Chao-Yang Hospital,Capital Medical University,Beifing 100043,China)

机构地区：[1]首都医科大学附属北京朝阳医院京西院区疝和腹壁外科,100043

出　　处：《中华消化外科杂志》2018年第11期1101-1105,共5页Chinese Journal of Digestive Surgery

基　　金：北京市医院管理局临床技术创新项目（XMLX201602）;北京市卫生系统高层次卫生技术人才培养计划（2015-3-031）

摘　　要：目的：探讨DynaMesh-IPST造口专用补片在腹壁造瘘口旁疝修补术中的应用价值。方法：采用回顾性队列研究方法。收集2013年3月至2017年4月首都医科大学附属北京朝阳医院收治的281例腹壁造瘘口旁疝患者的临床资料。281例患者均行腹腔镜联合开放人工材料腹壁造瘘口旁疝修补术，其中151例使用DynaMesh IPST造口专用补片，设为DynaMesh-IPST补片组；130例使用普通防粘连补片，设为普通补片组。观察指标：（1）术中及术后情况。（2）随访情况。患者术后1个月、3个月、6个月、1年采用门诊和电话方式进行随访，了解疝复发和长期并发症情况。随访时间截至2018年6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（P25，P75）和M（范围）表示，组间比较采用秩和检验。计数资料组间比较采用x2检验。结果：（1）术中及术后情况：281例患者均顺利完成腹腔镜联合开放人工材料腹壁造瘘口旁疝修补术。DynaMesh-IPST补片组和普通补片组患者手术时间分别为 100 min（60 min，120 min）和100 min（85 min，120 min），术中出血量分别为（34±15）mL和（42±36）mL，术后住院时间分别为17 d（13 d，24 d）和20 d（16 d，25 d），两组患者上述指标比较，差异均有统计学意义（Z=2.166，t=2.654，Z=2.795，P〈0.05）。DynaMesh-IPST补片组术后18例患者发生切口感染，其中2例合并肠漏；普通补片组术后36例患者发生切口感染，其中7例合并肠漏，两组患者术后切口感染比较，差异有统计学意义（x2=11.194，P〈0.05）；术后肠漏比较，差异无统计学意义（x2=4.234，P〉0.05）。54例发生术后切口感染的患者中，4例经手术清除补片及感染灶后痊愈，50例经换药、局部清创引流后痊愈。（2）随访情况：281例患者中，279例获得随访，其中DynaMesh-IPST补片组149例，普通补片组130例。随Objective：To investigate the application value of DynaMesh-IPST stoma dedicated mesh in parastomal hernia repair. Methods：The retrospective cohort study was conducted. The clinical data of 281 patients with parastomal hernia of abdominal wall who were admitted to Beijing ChaoYang Hospital of Capital Medical University between March 2013 and April 2017 were collected. Of 281 patients undergoing laparoscopic combined with open parastomal hernia repair with artificial materials, 151 using DynaMesh-IPST stoma dedicated mesh and 130 using ordinary antiadhesive mesh were respectively allocated into the DynaMesh-IPST mesh group and ordinary mesh group. Observation indicators： （1） intra and postoperative situations; （2） follow-up. follow-up using outpatient examination and telephone interview was performed to detect hernia recurrence and longterm complications at 1, 3, 6month and 1 year postoperatively up to June 2018. Measurement data with normal distribution were represented as ±s and comparison between groups was done by the t test. Measurement data with skewed distribution were described as M （P25,P75） and M （range）, and comparison between groups was done using rank sum test. Comparison of count data between groups was analyzed using the chisquare test. Results： （1） Intra and postoperative situations： 281 patients underwent successfully laparoscopic combined with open parastomal hernia repair with artificial materials. The operation time, volume of intraoperative blood loss and duration of postoperative hospital stay were 100 minutes （60 minutes, 120 minutes）, （34±15）mL, 17 days （13 days, 24 days） in the DynaMesh-IPST mesh group and 100 minutes （85 minutes,120 minutes）, （42± 36）mL and 20 days （16 days, 25 days） in the ordinary mesh group, with statistically significant differences between groups （Z=2.166, t=2.654, Z=2.795, P〈0.05）. The postoperative incisional infection and intestinal leakage were respectively detected in 18 and 2 patients in the DynaMe

关 键 词：造瘘口旁疝 疝修补术 补片修补术 DynaMesh—IPST补片 并发症 复发 

分 类 号：R656.2[医药卫生—外科学]