腹腔镜与开放式无张力修补术治疗腹壁疝临床对比研究

Clinical control study of laparoscopic procedures vs open mesh repair for ventral hernias

目的评价腹腔镜腹壁疝修补术(LVHR)的安全性与有效性。方法对2007年1月至2008年8月间上海交通大学医学院附属瑞金医院接受无张力修补术的68例腹壁疝病人(缺损长径≤20cm)的临床资料进行回顾性分析。结果LVHR31例,开放式腹壁疝修补术(OVHR)37例。随访时间1～21个月(中位时间11个月)。LVHR与OVHR在年龄、性别比、BMI和疝缺损大小上差异无统计学意义(P>0.05)。LVHR与OVHR的平均手术时间分别为(60.5±17.7)min和(75.5±30.3)min(P=0.017),平均术后住院天数分别为(6.2±2.5)d和(9.6±8.0)d(P=0.026),术后2周内恢复非限制性活动人数分别为96.8%和78.4%(P=0.026),差异均有统计学意义。两组术后第1天的疼痛评分VAS分别为5.6±1.2和6.3±1.3,差异有统计学意义(P=0.018),术后1周和1个月的VAS差异无统计学意义(P=0.932,P=0.056)。两组总并发症发生率分别为19.4%和24.3%(P=0.623),复发率分别为3.2%和5.6%(P=1.000),差异无统计学意义。两组的住院总费用分别为(18334±5336)元和(9508±9222)元,差异有统计学意义(P=0.000)。结论LVHR对于缺损长径<20cm的腹壁疝是安全有效的。

Objective To estimate the laparoscopic ventral hernia repair（LVHR）, focusing on the safety and efficiency of the operations. Methods The clinical data of 68 patients with ventral hernias （defect≤20cm） performed hernia reparing between January 2007 and August 2008 at Ruijin Hospital of Shanghai Jiao Tong University were analyzed retrospectively. Results Thirty-one patients underwent laparoscopic repair （LVHR）, and 37 patients underwent open mesh repair （OVHR）. The clinical outcome was determined by a median follow-up of 11 months（1-21 months） for the two groups. No significant differences were noticed between the two groups in age, sex, body mass index （BMI）, and hernia size. The mean operative time was （60.5±17.7）min for LVHR patients and （75.5±30.3）min for OVHR patients （P = 0.017）. The mean postoperative hospital stay was （6.2±2.5）d for LVHR patients and （9.6±8.0）d for OVHR patients （P = 0.026）. 96.8% of patients （30/31） were able to return to usual activity in 2 weeks for LVHR and 78.4% of patients （29/ 37） for OVHR （P=0.026）. LVHR patients felt less pain in the first day after operation （P= 0.018）, and there were no significant differences in visual-analogue pain scores between the two groups afterward. Complications occurred in 19.4 % of LVHR patients and 24.3 % of OVHR patients （P =0.623） with a recurrence rate of 3.2% in LVHR and 5.6% in OVHR patiems （P =1.000）. The mean cost was （18334±5336） yuan RMB for LVHR patients and （9508±9222） yuan RMB for OVHR patients （P=0.000）. Conclusion The short-term results indicate that laparoscopic technique is safe and effective for ventral hernia repairing with hernia defect less than 20cm.