【摘要】：目的:通過探討兩種手術(shù)方式治療復(fù)發(fā)性腹壁切口疝的臨床效果,證實腹腔鏡修補(bǔ)復(fù)發(fā)性腹壁切口疝的安全性及可行性。方法:回顧性總結(jié)2006年06月至2016年12月收治的102例復(fù)發(fā)性腹壁切口疝患者的臨床資料,其中Onlay修補(bǔ)法(肌鞘前的修補(bǔ))56例,腹腔鏡修補(bǔ)法46例,比較分析兩組手術(shù)時間、術(shù)后下地時間、術(shù)后住院時間、術(shù)后疼痛、術(shù)后并發(fā)癥、住院費(fèi)用及復(fù)發(fā)率。結(jié)果:腹腔鏡修補(bǔ)組的手術(shù)時間、住院費(fèi)用高于Onlay修補(bǔ)組,差異有統(tǒng)計學(xué)意義(P0.05);Onlay修補(bǔ)組術(shù)后血清腫7例,切口感染5例,腸管損傷4例,術(shù)后疼痛4例,不全性腸梗阻各3例,并發(fā)癥共計23例(41.07%)。腹腔鏡修補(bǔ)組術(shù)后血清腫2例,切口感染2例,腸管損傷5例,術(shù)后疼痛1例,不全性腸梗阻2例,并發(fā)癥共計12例(19.57%)。兩組患者并發(fā)癥經(jīng)對癥治療后均好轉(zhuǎn),未發(fā)生補(bǔ)片感染,慢性疼痛,腸瘺等。兩組比較,腹腔鏡修補(bǔ)組并發(fā)癥的發(fā)生率低于Onlay修補(bǔ)組(P0.05),術(shù)后住院時間、下床活動時間短于Onlay修補(bǔ)組,差異有統(tǒng)計學(xué)意義(P0.05)。結(jié)論:腹腔鏡修補(bǔ)術(shù)治療復(fù)發(fā)性腹壁切口疝具有術(shù)后下地時間早、術(shù)后住院時間短、術(shù)后并發(fā)癥少等優(yōu)點,但住院費(fèi)用高、手術(shù)時間長,兩者術(shù)后復(fù)發(fā)率相近。兩種手術(shù)方式治療復(fù)發(fā)性腹壁切口疝均為安全、有效的。兩者手術(shù)方式如何選擇應(yīng)根據(jù)患者實際情況及外科醫(yī)生的技術(shù)、經(jīng)驗決定。
[Abstract]:Objective: to investigate the safety and feasibility of laparoscopic repair of recurrent abdominal incisional hernia. Methods: the clinical data of 102 patients with recurrent abdominal wall incisional hernia from June 2006 to December 2016 were retrospectively reviewed, including 56 cases with Onlay repair (anterior muscle sheath repair) and 46 cases with laparoscopic repair. The operative time of the two groups was compared and analyzed. Postoperative floor time, postoperative hospitalization time, postoperative pain, postoperative complications, hospital expenses and recurrence rate. Results: the operative time and hospitalization cost of laparoscopic repair group were significantly higher than that of Onlay repair group. The difference was statistically significant (P0.05). There were 7 cases of postoperative serum swelling, 5 cases of incision infection, 4 cases of intestinal injury, 4 cases of postoperative pain and 3 cases of incomplete intestinal obstruction in the laparoscopic repair group. A total of 23 cases (41.07%) had complications. In the laparoscopic repair group, there were 2 cases of serum swelling, 2 cases of incisional infection, 5 cases of intestinal injury, 1 case of postoperative pain, 2 cases of incomplete intestinal obstruction, and 12 cases (19.57%) of complications. The complications of the two groups were improved after symptomatic treatment, no patch infection, chronic pain, intestinal fistula and so on. The incidence of complications in the laparoscopic repair group was lower than that in the Onlay repair group (P0.05). The postoperative hospitalization time and the time to get out of bed were shorter than those in the Onlay repair group (P0.05). Conclusion: laparoscopic repair for recurrent abdominal incisional hernia has the advantages of early operation time, short hospitalization time and less postoperative complications, but the cost of hospitalization is high, the operation time is long, and the recurrence rate of both is similar. Both surgical methods are safe and effective in the treatment of recurrent abdominal incisional hernia. The choice of the two surgical methods should be based on the actual situation of the patient and the surgeon's skill and experience.
【學(xué)位授予單位】：新疆醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R656.2

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