腹直肌肌皮瓣在腹部中线切口疝修补术的解剖学基础及疗效分析

The anatomical basis and therapeutic effects of repairing with musculocutaneous fiap for rectus abdominis in medium incisional hernia

目的探讨腹壁组织瓣在中、大型中线切口疝修补术的解剖学基础及效果。方法 (1)中线中、大型切口疝48例,年龄介于23～65岁,中型切口疝28例,其中男性18例,女性10例,大型切口疝20例,其中男性13例,女性7例,采用腹直肌肌皮瓣修补;(2)与同期52例中、大型中线切口疝开放法肌后补片无张力修补术对照,年龄介于20～67岁,中型切口疝29例,其中男性17例,女性12例,大型切口疝23例,其中男性13例,女性10例。结果腹直肌肌皮瓣在腹部中线切口疝修补术与补片修补术相比:(1)在复发率上,其中在中型切口疝中,复发率分别为:7.1%和3.4%,P>0.05,在大型切口疝中分别为:15.0%和4.3%,P>0.05。(2)腹壁异物感及术后慢性疼痛,在中型切口疝观察组发生率分别为:0%和10.7%,对照组分别为:41.3%和95.7%,P分别<0.05;在大型切口疝中,对照组分别为:0%和30%,在对照组分别为:34.5%和47.8%,P分别<0.05。结论腹直肌肌皮瓣在中、大型中线切口疝修补效果与无张力修补术相当,但术后不适及并发症较补片法相比优势明显。

Objective To investigate The anatomical basis and therapeutic effects of repairing with musculocutaneous flap for rectus abdominis in medium incisional hernia belonging to the middle or large types. Methods （1）The medium incisional hernia cases of middle and large types were 48, whose ages were between 20 to 67 and who had received the repair with patch; 29 middle types were divided into 17 males and 12 females,and 23 large types were divided into 13 males and and 7 females （2）Compared with another 52 cases with medium incisional hernia cases of middle and large types in the same time ,whose ages were between 23 to 65 and who had taken the repair with abdominal tissue ; 28 middle types were divided inot 18 males and 10females; 20 large types were divided into 13 males and 10 females. Result The repair with composite skin flap rectus compared with those repaired with patch：（1）the recurrence rate, middle-type incisional hernia group, the observation group was 7.1% and the control group was 3.4%, P〉O.O5;in large-type incisional hernia group, the observation group was 15.0% and the control group was 4.3% ,P〉0.05. （2）Foreign body sensation and chronic pain after operation, the rate, in middle-type incisional hernia group,the observation type were 0% and 0.7% and the control group were 41.3% and 95.7%, P〈0.05;in large-sized incisional hernia group,the observation group were 0% and 30% and the control group were 34.5% and 47.8%,P〈0.05. Conclusions The repair in medium incisional hernia of middle to large types with composite rectus musculocutaneous flaps has the same efficacy with the tension-free herniorrhaphy.,but has obviously superiority when it comes to complications and discomfort.