【摘要】：背景腹壁切口疝是腹部手術(shù)后較常見的并發(fā)癥。其不能自愈,且隨著病程和年齡的增加有逐漸增大的趨勢。因此,除有禁忌證者外,腹壁切口疝病人均需采取積極手術(shù)治療。在腹腔鏡腹壁切口疝修補(bǔ)術(shù)中,補(bǔ)片的地位無法取代。目前,補(bǔ)片的研究發(fā)展迅速,每種補(bǔ)片的優(yōu)點、缺點、特性以及適用范圍都在不斷被了解、被發(fā)現(xiàn)、被認(rèn)識。疝外科大夫應(yīng)知道如何選擇合適的補(bǔ)片。目的通過對使用不同補(bǔ)片進(jìn)行腹壁切口疝手術(shù)病人治療效果的分析及對比,結(jié)合相關(guān)文獻(xiàn)綜述,總結(jié)腹腔鏡腹壁切口疝修補(bǔ)術(shù)中的補(bǔ)片選擇及手術(shù)經(jīng)驗,為臨床醫(yī)師提供診治經(jīng)驗,使其能更準(zhǔn)確地選擇合適補(bǔ)片治療腹壁切口疝,從而獲得更滿意的治療效果。方法回顧性分析2011年6月至2017年1月山東大學(xué)齊魯醫(yī)院行腹腔鏡腹壁切口疝修補(bǔ)術(shù)的94例腹壁切口疝病人的臨床資料,手術(shù)方式均為腹腔內(nèi)網(wǎng)片修補(bǔ)法(intraperitoneal onlay mesh,IPOM),固定方式均為螺旋型縫釘釘合+縫線懸吊固定,根據(jù)不同補(bǔ)片進(jìn)行分組,對手術(shù)時間、術(shù)中出血量、術(shù)后體溫、抽血化驗指標(biāo)、術(shù)后胃腸道功能恢復(fù)時間、切口及戳孔感染、持續(xù)腹腔引流時間、總腹腔引流量、術(shù)后住院時間、醫(yī)療花費、血清腫、補(bǔ)片感染、腸痿、慢性疼痛和疝復(fù)發(fā)發(fā)生情況進(jìn)行數(shù)據(jù)分析。結(jié)果文章共納入94例腹壁切口疝病人,其中Composix E/X組28例,Parietex Composite組28例,Sepramesh組38例。3組病人的年齡、性別組成、體重、疝環(huán)大小均無統(tǒng)計學(xué)差異(P0.05),具有可比性。ComposixE/X組并發(fā)癥總發(fā)生率、血清腫發(fā)生率均高于 Parietex Composite 組及 Sepramesh 組(P0.01),Parietex Composite組、Sepramesh組持續(xù)腹腔引流時間、總腹腔引流量、醫(yī)療花費則高于Composix E/X組(P0.01)。而在手術(shù)時間、術(shù)中出血量、術(shù)后體溫、抽血化驗指標(biāo)、切口及戳孔感染發(fā)生率、術(shù)后住院時間、腸瘺發(fā)生率、補(bǔ)片感染、慢性疼痛和疝復(fù)發(fā)上無統(tǒng)計學(xué)差異(P0.05)。結(jié)論腹腔鏡腹壁切口疝修補(bǔ)術(shù)(IPOM術(shù)式)是安全、有效的。與腹腔內(nèi)置入補(bǔ)片相關(guān)的術(shù)后并發(fā)癥包括血清腫、補(bǔ)片感染、腸痿、慢性疼痛等。補(bǔ)片的選擇需綜合考慮病人病情、經(jīng)濟(jì)負(fù)擔(dān)能力及術(shù)者臨床經(jīng)驗、手術(shù)技巧等因素。選擇合適的補(bǔ)片可以獲得更滿意的治療效果。對不同的病例宜采用個體化治療方案。
[Abstract]:Background abdominal incisional hernia is a common complication after abdominal surgery. It can not heal itself, and it tends to increase gradually with the increase of course of disease and age. Therefore, in addition to contraindications, abdominal incisional hernia patients need to take active surgical treatment. In laparoscopic hernia repair with abdominal incision, the position of patch can not be replaced. At present, the research of patch is developing rapidly, and the advantages, disadvantages, characteristics and scope of application of each patch are constantly understood, discovered and recognized. Hernia surgeons should know how to choose the right patch. Objective to analyze and compare the therapeutic effects of different patches in the treatment of abdominal incisional hernia, and to summarize the patch selection and surgical experience in laparoscopic abdominal incisional hernia repair combined with the review of related literature. To provide clinicians with experience in diagnosis and treatment, so that they can more accurately select appropriate patches for the treatment of incisional hernia of abdominal wall, so as to obtain more satisfactory therapeutic effect. Methods the clinical data of 94 patients with abdominal incisional hernia treated by laparoscopy in Qilu Hospital of Shandong University from June 2011 to January 2017 were analyzed retrospectively. all of them were treated with intraabdominal mesh repair (intraperitoneal onlay mesh,IPOM). The fixation methods were spiral sutures and stitches suspended and fixed, which were divided into groups according to different patches. The operation time, intraoperative blood loss, postoperative body temperature, blood sampling test index, postoperative gastrointestinal function recovery time, incision and puncture hole infection were divided into two groups: operation time, intraoperative bleeding volume, postoperative body temperature, blood sampling test index, postoperative gastrointestinal function recovery time, incision and puncture hole infection. The data of continuous abdominal drainage, total abdominal drainage, postoperative hospital stay, medical expenses, serum swelling, patch infection, intestinal impotence, chronic pain and hernia recurrence were analyzed. Results there were 94 patients with incisional hernia of abdominal wall, including 28 patients in, Parietex Composite group and 38 patients in Sepramesh group, including 28 patients in, Parietex Composite group and 38 patients in Sepramesh group. There was no significant difference in age, sex composition, body weight and hernia ring size among the three groups (P 0.05). The total incidence of complications and serum swelling in ComposixE / X group were higher than those in Parietex Composite group and Sepramesh group (P 0.01), Parietex Composite group, Sepramesh group), and the total abdominal drainage rate was higher in ComposixE / X group than that in ComposixE / X group and ComposixE / X group. The cost of medical treatment was higher than that of Composix E 鈮，

本文編號：2485115