腹壁切口疝补片修补术后复发的再手术治疗

Reoperation of Recurrent Incisional Hernia after Mesh Repair with Prosthetic Patch

目的总结腹壁切口疝补片修补术后复发再次手术治疗的经验。方法回顾性分析我院2007年1月至2010年12月期间收治的16例腹壁切口疝补片修补术后复发再次手术患者的资料。结果所有患者均再次采用补片进行修补,其中13例除去旧补片置入新补片修补,2例新补片与原补片重叠并扩大范围修补,1例在原补片上直接重叠新补片修补。术后所有患者切口均Ⅰ期愈合,3例发生补片上方积液,经穿刺加压后治愈。术后住院时间7～16 d,平均9 d。术后引流管拔除时间2～7 d,平均4 d。所有患者均获随访,随访时间5～36个月,平均20个月,1例有轻微腹壁异物感,无修补区慢性疼痛,无疝复发。结论补片修补术后复发性切口疝再次手术时需综合考虑复发疝的位置以及既往选用的补片类型和修补方法,再次手术需选用合适的补片及修补方法方可取得满意效果。

Objective To summarize the experiences and methods on reoperation of recurrent incisional hernia after mesh repair with prosthetic patch.Methods Sixteen patients who got reoperation from January 2007 to December 2010 because of recurrent incisional hernia after mesh repair were analyzed retrospectively.Results All patients received prosthetic patch repair for reoperation.Thirteen patients received new mesh repair accompanied with old mesh removal,repair conducted by suturing new mesh with old mesh together in two patients,and repair performed by new mesh overlapping the old mesh in one patient.All patients recovered with primary wound healing.Fluid upon the mesh occurred in 3 patients and cured by percutaneous puncture and pressure dressing.Postoperative hospital stay was 7 to 16 days and the average 9 days.The drainage was removed 2 to 7 days after operation and the average was 4 days.All the 16 patients were followed up.And during a follow-up range of 5 to 36 months and the average 20 months,there was slight foreign body sensation in one patient,no chronic pain in wound area occurred.And no abdominal wall hernia recurrence occurred.Conclusions Reoperation of recurrent incisional hernia after mesh repair need to consider the recurrent position,material of the previous mesh,and the previous surgical methods,and should select appropriate prosthetic patch and surgical procedure,then could gain satisfied results.