腹腔镜完全腹膜外补片修补术治疗脐疝、脐旁疝的疗效分析  

The curative effect analysis of laparoscopic totally extraperitoneal sublay repair in the treatment of umbilical hernia or paraumbilical hernia

作　　者：朱江 梅虎 庄云峰 宋思凯 张军 杨孟选 ZHU Jiang;MEI Hu;ZHUANG Yun-feng(Department of Abdominal Surgery,the Third People’s Hospital of Xinjiang,Urumqi 830091,China)

机构地区：[1]新疆维吾尔自治区第三人民医院腹部外科,新疆乌鲁木齐830091 [2]复旦大学附属闵行医院,上海市闵行区中心医院胃肠外科,上海市闵行区复旦医教研协同发展研究院

出　　处：《腹腔镜外科杂志》2021年第5期363-366,共4页Journal of Laparoscopic Surgery

基　　金：新疆维吾尔自治区卫生健康青年医学科技人才专项科研项目(WJWY-201941)。

摘　　要：目的:对比分析腹腔镜完全腹膜外补片修补术(TES)与腹腔镜腹腔内补片修补术(IPOM)治疗脐疝、脐旁疝的临床疗效,探讨TES的安全性与局限性。方法:选取2018年6月至2020年6月行腹腔镜修补术的48例脐疝、脐旁疝患者进行前瞻性研究,随机分为两组,对照组25例,接受IPOM;研究组23例,接受TES。术后随访6个月。对比分析两组围术期相关指标(手术时间、出血量、腹腔引流时间、进食时间、术后1周疼痛评分、住院时间、住院费用)、术后近期并发症(切口裂开、术区积液、脐部皮肤坏死、术区血清肿、急性肠梗阻)及远期并发症(慢性疼痛、慢性不全性肠梗阻、肠瘘、疝复发)。结果:研究组手术时间长于对照组(P<0.001),而腹腔引流时间、术后1周疼痛评分、住院时间、住院费用、术后远期并发症发生率均低于对照组,差异有统计学意义(P<0.05)。两组手术出血量、进食时间、术后近期并发症发生率差异无统计学意义。结论:TES治疗脐疝、脐旁疝较IPOM可能更具优势,但TES手术时间长,操作难度大,治疗>5 cm的脐疝仍存在局限性。Objective:To compare and analyze the curative effect of laparoscopic totally extraperitoneal sublay repair(TES)and laparoscopic intraperitoneal onlay mesh(IPOM)in the treatment of umbilical hernia or paraumbilical hernia,and to explore the safety and limitation of TES.Methods:From Jun.2018 to Jun.2020,48 patients with umbilical hernia or paraumbilical hernia who want to undergo laparoscopic hernia repair were selected for the prospective study.Two groups were randomly divided,25 patients in the control group underwent IPOM and 23 patients in the study group underwent TES.The follow-up time was 6 months.Related indexes were compared and analyzed between the two groups,including the perioperative data(operation time,blood loss,abdominal drainage tube removal time,fasting time,pain score 1 week after operation,hospital stay and hospitalization costs),the incidence of short-term postoperative complications(incision disruption,effusion in surgical area,umbilical skin necrosis,seroma,acute intestinal obstruction)and long-term postoperative complications(chronic pain,chronic incomplete intestinal obstruction,intestinal fistula,hernia recurrence).Results:The study group had significantly longer operation time than the control group(P<0.001),but it had significantly shorter drainage tube removal time and hospital stay,less pain score 1 week after operation,hospitalization costs and incidence of long-term postoperative complications than the control group(P<0.05).There were no significant differences in two groups about blood loss,fasting time and the incidence of short-term postoperative complications.Conclusions:TES might be better than IPOM for treating umbilical hernia or paraumbilical hernia,but it has longer surgical time and needs more difficult operation technology.Furthermore,TES has some limitations for treating umbilical hernia or paraumbilical hernia which size is greater than 5 cm.

关 键 词：疝 脐 疝修补术 完全腹膜外 腹腔镜检查 疝补片 

分 类 号：R656.23[医药卫生—外科学]