腹壁切口疝修补手术的临床应用价值  

Clinical application value of abdominal incisional hernia repair

作　　者：闵凯[1] 任骏[1] 吴彪[1] 赵春翔[1] 王辰啸 陈华涛[1] 李晓辉[1] 肖新波[1] 郭建辉 孟庆彬[1] Min Kai;Ren Jun;Wu Biao;Zhao Chunxiang;Wang Chenxiao;Chen Huatao;Li Xiaohui;Xiao Xinbo;Guo Jianhui;Meng Qingbin(Second Department of Gastrointestinal Surgery,Treatment Center for Hernia and Abdominal Wall Surgery,Wuhan No.1 Hospital,Wuhan 430022,China)

机构地区：[1]武汉市第一医院胃肠二外科,疝和腹壁外科治疗中心,430022

出　　处：《中华消化外科杂志》2019年第11期1032-1036,共5页Chinese Journal of Digestive Surgery

基　　金：吴阶平临床科研专项基金(320.6750.16209)。

摘　　要：目的探讨腹壁切口疝修补手术的临床应用价值。方法采用回顾性描述性研究方法。收集2013年1月至2017年12月武汉市第一医院收治的104例行腹壁切口疝修补手术患者的临床资料;男38例,女66例;年龄为(58±4)岁,年龄范围为31~85岁。患者均采取补片置入方式完成腹壁切口疝修补手术。观察指标:(1)术中情况。(2)并发症情况。(3)随访情况。采用电话问卷方式进行随访,了解患者术后复发情况。随访时间截至2019年6月。正态分布的计量资料以Mean±SD表示,偏态分布的计量资料以M(P25,P75)表示;计数资料以绝对数表示。结果(1)术中情况:104例患者顺利完成腹壁切口疝修补手术,手术时间为(111±18)min,术后住院时间为(6.1±2.4)d。104例患者中,行开放手术29例,行腹腔镜手术38例,行杂交手术37例。29例行开放手术患者中,腹壁缺损部位在脐下区(M4型)25例、胁腰部(L2型)2例、髂部(L3型)2例。29例行开放手术患者的补片放置于腹壁肌肉后。38例行腹腔镜手术患者中,腹壁缺损部位在剑突下(M1型)9例、上腹部(M2型)23例、肋缘下(L1型)6例。38例行腹腔镜手术患者的补片放置于腹膜腔内。37例行杂交手术患者中,腹壁缺损部位在脐部(M3型)27例、耻骨上区(M5型)10例。37例行杂交手术患者的补片放置于腹膜腔内。(2)并发症情况:29例行开放手术患者中,7例发生并发症,其中术后腹壁修补区域疼痛4例、切口愈合不良1例、修补区域浆液肿2例。38例行腹腔镜手术患者中,2例发生并发症,均为术后腹壁修补区域疼痛。37例行杂交手术患者中,6例发生并发症,其中切口愈合不良2例、修补区域浆液肿4例。104例患者中,6例术后腹壁修补区域疼痛患者,经局部封闭及镇痛治疗均缓解;3例切口愈合不良患者,经局部换药及二次清创缝合后愈合良好;6例修补区域浆液肿患者,经穿刺抽液及加压包扎后痊愈。无肠瘘、肠梗阻、腹Objective To investigate the clinical application value of abdominal incisional hernia repair.Methods The retrospective and descriptive study was conducted.The clinical data of 104 patients who underwent abdominal incisional hernia repair in the Wuhan No.1 Hospital from January 2013 to December 2017 were collected.There were 38 males and 66 females,aged(58±4)years,with a range from 31 to 85 years.All patients underwent abdominal incisional hernia repair by patch implantation.Observation indicators:(1)intraoperative conditions;(2)complications;(3)follow up.Follow up by telephone questionnaires was performed to detect the postoperative recurrence up to June 2019.Measurement data with normal distribution were expressed as Mean±SD,measurement data with skewed distribution were expressed as M(P25,P75),and count data were expressed as absolute numbers.Results(1)Intraoperative conditions:all the 104 patients underwent the abdominal incisional hernia repair successfully.The operation time,duration of postoperative hospital stay were(111±18)minutes and(6.1±2.4)days.Among the 104 patients,29 underwent open surgery,38 underwent laparoscopic surgery,and 37 underwent hybrid surgery.Among the 29 patients undergoing open surgery,25 had defect area in the subumbilical region(M4 type),2 had defect area in the hypochondrial region(L2 type),and 2 had defect area in the ilium region(L3 type);all patients had patches placed in posterior muscle space.Among the 38 patients undergoing laparoscopic surgery,9 had subxiphoid defects(M1 type),23 had epigastric defects(M2 type),and 6 had subcostal defects(L1 type);all patients had patches placed in intraperitoneal cavity.Among the 37 patients undergoing hybrid surgery,27 had umbilical defects(M3 type)and 10 had suprapubic defects(M5 type);all patients had patches placed in intraperitoneal cavity.(2)Complications:among the 29 patients undergoing open surgery,7 had complications,including 4 of pain in the repaired area of abdominal wall,1 of poor wound healing,and 2 of seroma in the repair

关 键 词：疝 腹壁切口疝 修补手术 开放 杂交 临床应用 腹腔镜检查 

分 类 号：R65[医药卫生—外科学]