自固定聚丙烯/聚乳酸复合补片改善腹股沟疝无张力修补后的慢性疼痛  

Self-fixating polypropylene/poly(lactic acid) mesh for treatment of chronic pain following tension-free repair of inguinal hernia

作　　者：黄亮[1] 余壮明[1] 李军[1] 李昌伟[1] Huang Liang;Yu Zhuang-ming;Li Jun;Li Chang-wei(Department of General Surgery,Affiliated Hospital of Hainan Medical University,Haikou 570100,Hainan Province,China)

机构地区：[1]海南医学院附属医院普通外科,海南省海口市570100

出　　处：《中国组织工程研究》2018年第6期908-913,共6页Chinese Journal of Tissue Engineering Research

摘　　要：背景:目前已有多项关于自固定补片应用于腹股沟疝无张力修补术的临床研究发表,但是否自固定补片优于普通缝合补片仍存在争议。目的:对比自固定聚丙烯/聚乳酸复合补片及普通聚丙烯补片修复后,腹股沟疝患者术后慢性疼痛的差异。方法:将90例男性初发单侧腹股沟疝患者随机分为2组,均行腹股沟疝无张力修补治疗,其中自固定补片组(n=45)采用自固定聚丙烯/聚乳酸复合补片,对照组(n=45)采用传统聚丙烯补片,记录两组手术时间及住院时间;治疗后1 d、10 d、1个月、3个月、6个月,采用目测类比评分评估患者术后疼痛及慢性疼痛情况;治疗后随访6个月,观察两组并发症发生情况。结果与结论:(1)两组住院时间比较差异无显著性意义,自固定补片组手术时间短于对照组(P<0.05);(2)两组治疗后1 d的疼痛比较差异无显著性意义,自固定补片组治疗后10 d、1个月、3个月、6个月的疼痛轻于对照组(P<0.05);(3)治疗后随访6个月,除了对照组有5例患者自述有术区补片异物感之外,两组患者中均无尿潴留、皮下血肿、伤口感染及复发等情况出现;(4)结果表明,与传统聚丙烯补片相比,采用自固定聚丙烯/聚乳酸复合补片对单侧腹股沟疝患者进行无张力修补,因其无需缝合有利于缩短手术时间,另外其自身的结构特点有助于减轻患者的慢性疼痛及不适感。BACKGROUND:Increasing clinical studies have reported the application of self-fixating mesh in the tension-free repair of inguinal hernia,but whether the self-fixating mesh is superior to the common suture mesh is still in dispute.OBJECTIVE:To compare the effects of self-fixating polypropylene/poly(lactic acid)mesh and polypropylene mesh on chronic pain after tension-free repair of inguinal hernia.METHODS:A total of 90 male patients with primary inguinal hernia were randomly divided into two groups:self-fixating mesh and control groups(n=45 per group).All patients underwent tension-free hernioplasty followed by self-fixating polypropylene/poly(lactic acid)mesh in the self-fixating mesh group and polypropylene mesh in the control group.Operation time and length of hospital stay were recorded;complications and recurrence rate in the two groups were observed at 6 months after operation;and postoperative pain and chronic pain were assessed by the visual analog scale(VAS)at postoperative 1,10 days,1,3,6 months.RESULTS AND CONCLUSION:(1)Compared with the control group,the operation time was shorter in the self-fixating mesh group(P<0.05),but there was no significant difference in the length of hospital stay between the two groups.(2)The VAS scores showed no significant difference between the two groups at postoperative 1 day,but the VAS scores were significantly better in the self-fixating mesh group than the control group at 10 days,postoperative 1,3,6 months(P<0.05).(3)During the 6-month follow-up,there were no urinary retention,subcutaneous hematoma,wound infection and recurrence in the two groups except five patients in the control group who complained of a foreign body sensation.To conclude,compared with the traditional polypropylene mesh,the use of self-fixating polypropylene/poly(lactic acid)mesh can shorten operation time and reduce pain and discomfort of patients with unilateral inguinal hernia undergoing tension-free hernioplasty.

关 键 词：聚丙烯类 疝 腹股沟 疼痛 组织工程 

分 类 号：R318[医药卫生—生物医学工程]