本文選題：切口疝 + 疝修補(bǔ)術(shù)�。� 參考：《浙江大學(xué)》2017年碩士論文

【摘要】：背景腹壁切口疝是腹部外科術(shù)后常見(jiàn)的長(zhǎng)期并發(fā)癥之一,發(fā)生率在11-20%,切口疝一旦形成,保守治療難以治愈,進(jìn)展后還可能導(dǎo)致腸粘連及腸絞窄,甚至危及生命,手術(shù)治療是唯一的有效手段。開(kāi)放式修補(bǔ)是傳統(tǒng)的手術(shù)方式,隨著腹腔鏡手術(shù)及修補(bǔ)材料的不斷發(fā)展,腹腔鏡切口疝修補(bǔ)術(shù)應(yīng)用越來(lái)越普遍,近年一些專家還將腹腔鏡技術(shù)與開(kāi)放術(shù)式相結(jié)合,形成雜交技術(shù)(Hybrid Technique incisional hernia repair),大宗文獻(xiàn)報(bào)道比較了各種術(shù)式的療效,但結(jié)果差異性很大,哪種術(shù)式是才是最理想的手術(shù)方式目前仍存在爭(zhēng)議。目的對(duì)比分析開(kāi)放術(shù)式、雜交術(shù)式、腹腔鏡術(shù)式三種手術(shù)方式治療腹壁切口疝的臨床療效,為外科醫(yī)生選擇最理想的術(shù)式提供參考。方法回顧性分析浙江大學(xué)醫(yī)學(xué)院附屬邵逸夫醫(yī)院2010年1月至2016年6月行腹壁切口疝修補(bǔ)術(shù)的86例患者的臨床資料,其中OIHR組(開(kāi)放組)28例,HTIHR組(雜交組)27例,LIHR組(腹腔鏡組)31例,在排除年齡、性別、BMI、ASA分級(jí)、合并癥等一般資料的差異性之后,對(duì)比三組術(shù)中術(shù)后的一些臨床指標(biāo)有無(wú)統(tǒng)計(jì)學(xué)意義,其中計(jì)量資料包括手術(shù)時(shí)間、術(shù)中出血、腹壁缺損大小、術(shù)后恢復(fù)進(jìn)食時(shí)間、術(shù)后使用鎮(zhèn)痛藥次數(shù)、住院時(shí)間等,計(jì)數(shù)資料包括血清腫/漿液腫,切口感染,肺部感染,腹壁疼痛等相關(guān)并發(fā)癥及復(fù)發(fā)情況。結(jié)果三組患者在一般資料、切口疝類型、術(shù)中出血、住院時(shí)間、并發(fā)癥上無(wú)顯著性差異。LIHR組較其他兩組腹壁缺損面積小(P0.05),術(shù)后進(jìn)食時(shí)間(即腸道恢復(fù)時(shí)間)短(P0.05),使用鎮(zhèn)痛藥次數(shù)少(P0.05),有統(tǒng)計(jì)學(xué)意義。較OIHR組手術(shù)時(shí)間短,但差異不顯著。HTIHR組較LIHR組手術(shù)時(shí)間長(zhǎng)(P0.05),有明顯統(tǒng)計(jì)學(xué)差異。OIHR組復(fù)發(fā)率21.4%(6/28),LIHR組復(fù)發(fā)率3.2%(1/31),HTIHR組無(wú)復(fù)發(fā)病例,有顯著統(tǒng)計(jì)學(xué)差異。結(jié)論腹腔鏡腹壁切口疝修補(bǔ)術(shù)與雜交技術(shù)切口疝修補(bǔ)術(shù)均是安全有效的可替代傳統(tǒng)開(kāi)放術(shù)式的手術(shù)方式,腹腔鏡術(shù)式較開(kāi)放術(shù)式有損傷小、手術(shù)時(shí)間短、疼痛少、恢復(fù)快等優(yōu)勢(shì)。而對(duì)于較復(fù)雜較大的切口疝及復(fù)發(fā)疝,雜交技術(shù)將開(kāi)放術(shù)式直視分離與腹腔鏡術(shù)式直視固定補(bǔ)片的優(yōu)勢(shì)結(jié)合起來(lái),從而提高了手術(shù)療效、降低復(fù)發(fā)率。另外隨著修補(bǔ)材料、固定材料、手術(shù)方式尤其是機(jī)器人手術(shù)、術(shù)后評(píng)估等技術(shù)的不斷發(fā)展,腹腔切口疝的手術(shù)治療將會(huì)取得越來(lái)越好的效果。
[Abstract]:Background incisional hernia of abdominal wall is one of the common long-term complications after abdominal surgery. The incidence of incisional hernia is 11-20. Once incisional hernia is formed, conservative treatment is difficult to cure. Surgical treatment is the only effective means. Open repair is a traditional surgical method. With the development of laparoscopic surgery and repair materials, laparoscopic incisional hernioplasty is becoming more and more common. In recent years, some experts have combined laparoscopic technique with open operation. Hybrid Technique incisional hernia repairn (hybrid Technique incisional hernia repairn) was formed. A large number of literature reports have compared the efficacy of various surgical procedures, but the results are very different, which is the most ideal operation method is still controversial. Objective to compare and analyze the clinical effects of open operation, hybrid operation and laparoscopic operation in the treatment of abdominal incisional hernia, and to provide a reference for surgeons to choose the most ideal operation. Methods the clinical data of 86 patients undergoing incisional herniorrhaphy of abdominal wall from January 2010 to June 2016 in run run run Shaw Hospital affiliated to Zhejiang University Medical College were retrospectively analyzed. Among them, OIHR group (open group, 28 cases with HTIHR) (hybridization group, 27 cases), LIHR group (LIHR group, 31 cases), after ruling out the difference of age, sex, BMIASA grade, complication and other general data, etc. There were significant differences in some clinical indexes between the three groups, including operative time, intraoperative bleeding, abdominal wall defect, postoperative recovery time, times of using analgesics after operation, hospitalization time and so on. Counting data included seroderma / seroderma, incision infection, pulmonary infection, abdominal wall pain and other related complications and recurrence. Results three groups of patients in general information, incisional hernia type, intraoperative bleeding, hospital stay, There was no significant difference in complications. The area of abdominal wall defect in the LIHR group was smaller than that in the other two groups. The feeding time (that is intestinal recovery time) after operation was shorter than that in the other two groups (P 0.05), and the number of times of using analgesics was less than that of the other two groups (P 0.05). The time of operation was shorter than that of OIHR group, but the difference was not significant. The operation time of HTIHR group was longer than that of LIHR group (P 0.05), there was significant difference. The recurrence rate of OIHR group was 21. 4% / 28% LIHR group, the recurrence rate was 3. 2% / 31% HTIHR group and there were no recurrence cases, there was significant statistical difference. Conclusion Laparoscopic incisional herniorrhaphy and hybrid herniorrhaphy are safe and effective alternative to traditional open hernia repair. Laparoscopy has less injury, shorter operation time and less pain than open operation. Recover advantages such as speed. For the more complex and larger incisional hernia and recurrent hernia, the hybrid technique combined the advantages of open open surgery with laparoscopic direct vision fixed patch to improve the curative effect and reduce the recurrence rate. In addition, with the development of repair materials, fixation materials, surgical methods, especially robotic surgery, postoperative evaluation and other technologies, surgical treatment of abdominal incisional hernia will achieve more and more good results.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R656.2

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