腹腔镜术后切口疝高风险患者不同切口关闭方式效果评价

Effect evaluation of different incision closure of patients with high-risk of incisional hernia after laparoscopic surgery

目的比较不同的切口关闭方式对腹腔镜术后切口疝高风险患者发生切口疝的影响。方法选取杭州市第三人民医院2010年1月—2013年1月行腹腔镜胆囊切除术的患者172例,所有患者术前预防性运用头孢呋辛。所有患者术中均行标准脐部贯通切口,腹腔镜胆囊切除手术完成后根据患者分组采用不同关闭方式。A组患者采用脐切口缝合关闭（3针）;B组关闭前患者从脐切口置入内置网片（Aspide）,内置网片直径5 cm,可吸收缝线固定。术后所有患者应用相同剂量止痛剂。术后第2天对患者腹部疼痛进行自主评分,出院后1个月、6个月及12个月复诊,评估是否发生切口疝及切口是否感染。结果 A组患者平均手术时间为（70.1±22.3）min,与B组患者（69.5±23.5）min差异无统计学意义（P〉0.05）。A组患者术后住院时间1-5 d,B组患者术后住院时间1-11 d,但2组患者住院时间中位数均为2 d。A组术后疼痛指数为3.7±1.1,B组疼痛指数为2.2±0.9,差异具有统计学意义（P〈0.05）。术后A组4例患者伤口感染,B组1例,差异具有统计学意义（P〈0.05）。所有伤口感染均发生在术后1个月内。除切口疝外,其他并发症发生情况：A组22例（25.5%）,B组16例（18.6%）,差异具有统计学意义（P〈0.05）。A组切口疝发生率为8.1%,B组为2.3%,差异具有统计学意义（P〈0.01）。结论对于切口疝高风险患者,腹腔镜胆囊切除术后内置网片关闭脐部切口可显著降低切口疝发生率、术后疼痛及其他并发症发生率。

Objective To compare the effect on incisional hernia occurrence of different incision closure of patients with high-risk of ineisional hernia after laparoseopic surgery. Methods All 172 cases of patients having aparoseopic cholecys- tectomy from January 2010 to 2013 in our hospital were selected. Ceflriaxone cefuroxime was preventively applied on all the patients before operation. Standard umbilicus penetrating-incision was given in all the operation, and different methods of incision closure were selected according to grouping after laparoscopic cholecystectomy finished. Umbilical incision closed with 3 stitches was applied in A group. Aspide was applied before umbilical incision closed in B group, and fixed by absorbable sutures. The same dose of analgesics was applied in the two groups. Self scoring was given for pain in the abdo- men the day after operation. Further consultation was given 1,6 and 12 months after hospital discharge to evaluate whether there was incisional hernia or incision infection. Results The mean operation time in A group was （ 70.1 ± 22.3 ） min, and （69.5 ± 23.5 ） min in B group. There was no statistical differences of mean operation time between the two groups （ P 〉 0.05 ）. Postoperative hospital stay in A group was 1 - 5 days, while 1 - 11 days in B group. The median of hospital stay in both groups was 2 days. Postoperative pain index in A group was 3.7 ± 1.1, while 2.2 ± 0.9 in B group. There were statistical differences of postoperative pain index between the two groups（ P 〈 O. 05 ）. There were 4 cases of incision infection in A group after operation, while 1 case in B group. There were statistical differences of cases of incision infection between the two groups （ OR = 2.04, P 〈 O. 05 ）. All incision infection occurred in one month after operation. There were 22 cases of other complications occurring other than incisional hernia in A group（25.5% ） ,while 16 cases in B group （ 18.6% ）. There were statistical differences of other complications occurring between the two groups （ P 〈 0.05 ）. The in- cidence of ineisional hernia in A group was 8.1% ,while 2.3% in B group. There were statistical differences of incidence of incisional hernia between the two groups （ OR = 8.4, P 〈 0.01 ）. Conclusion To patients with high-risk of incisional hernia,incidences of incisional hernia, pain after surgery and other complications could be reduced by applying aspide closing umbilical incision after laparoscopic cholecysteetomy.