人工材料修补老年腹壁切口疝的手术方法探讨

Analysis of repair method of abdominal incisional hernias with synthetic materials in the elderly

目的总结采用人工材料无张力修补腹壁切口疝的临床经验和方法，探讨人工材料置于腹壁不同的层次是否影响疗效。方法回顾性分析67例老年腹壁切口疝的手术方法、围手术期处理、术后并发症、引流的放置、抗生素的使用及随访结果。根据人工材料放置位置不同分为两组：前鞘前、腹膜前，比较两组间一期愈合和复发情况。结果患者平均年龄68．52岁；全部采用人工材料修补；人工材料分别放置于前鞘前（皮下）42例、腹膜前（肌层后）25例；术后放置负压吸引49例（73．13％），全部使用抗生素预防感染；术后皮下积液6例（8．96％），切口延迟愈合5例（7．46％），肺部感染5例（7．46％）；随访2．4年（0．5～4年），两组患者均无复发，两组间一期愈合率无显著差别。结论采用人工材料行无张力疝修补是合适的治疗老年腹壁切口疝的方法，人工材料置于腹壁不同层次均可取得良好疗效，良好的围手术期处理是疗效的重要保证。

Objective To summarize the clinical experience of repair of abdominal incisional hernia with tension-free procedures by using polypropylene mesh, and to discuss the effects of different position of the mesh on the outcome. Method A retrospective study was conducted on 67 elderly patients with abdominal incisional hernia. The surgical techniques, perioperative treatment, complications of operation, drainage, antibiotics, and the outcome were analysed. Based on the position of mesh, 67 patients were divided into two groups ： prefascia and preperitoneal group. The wound healing and recurrences of different groups were compared. Result The patient＇ s mean age was 68.52 years （ range 60-84 years ）. All were treated with synthetic materials. The mesh were placed on subcutaneous （prefascia） in 42 patients, on retromuscolar （prepcritoneal） in 25 patients. Drainage were used in 49 patients（73.13% ）. Antibiotics were used in all patients. The postoperative complication include subcutaneous seroma in 6 cases（ 8.96% ）, delayed wound healing in 5 cases（7.46% ）, pulmonary infection in 5 cases（7.46% ）. The average follow-up was 2.4 years （0.5-4 years）. There is no recurrence and no difference between two groups. Conclusion Tension free hernia repair by using synthetic materials is a reliable surgical techniques . The mesh can be placed on different layer of abdomen. Appropriate perioperative treatment is essential to outcome.