杂交修补技术与腹腔镜腹腔内补片植入术治疗腹壁切口疝的疗效比较

Comparison of the clinical efficacy between hybrid technique and laparoscopic intraperitoneal onlay mesh for the abdominal incisional hernia repair

目的:探讨杂交修补技术与腹腔镜腹腔内补片植入术(intraperitoneal onlay mesh,IPOM)治疗腹壁切口疝的疗效。方法:回顾分析2010年1月至2014年1月收治的36例腹壁切口疝患者的临床资料,其中16例行杂交修补技术,20例行腹腔镜IPOM。结果:36例手术均获成功。IPOM组出现1例血肿,1例肠漏,并发症发生率为10%(2/20)。杂交修补技术组均未出现感染、血肿、肠漏及术后慢性疼痛等并发症。与腹腔镜IPOM组相比,杂交修补技术组出血量[(68.99±23.82)ml vs.(67.22±26.59)ml,t=0.140,P=0.890]、下床活动时间[(2.11±0.78)d vs.(2.00±0.71)d,t=0.316,P=0.756]、住院时间[(8.44±2.01)d vs.(8.22±2.49)d,t=0.209,P=0.837]、术后患者VAS评分[术后第1天:(5.89±1.76)vs.(5.78±1.48)分,t=-0.145,P=0.887;术后第3天:(3.76±0.87)vs.(3.11±0.93)分,t=-1.313,P=0.208]及需要的止痛剂剂量[(4.00±1.41)支vs.(4.11±1.54)支,t=-0.160,P=0.875]差异均无统计学意义,但手术时间[(189.44±41.50)min vs.(247.78±40.55)min,t=-3.016,P=0.008]明显减少。结论:与腹腔镜IPOM相比,杂交修补技术治疗腹壁切口疝同样安全、有效,且能缩短手术时间,近期效果显著,值得推广。

Objective： To evaluate the clinical efficacy between hybrid technique and laparoscopic intraperitoneal onlay mesh（ IPOM） for the abdominal incisional hernia repair. Methods： A retrospective analysis was made in 16 cases of abdominal incisional hernia repaired by the hybrid technique and 20 cases of incisional hernia repaired by the laparoscopic IPOM from Jan. 2010 to Jan.2014. Results： All procedures were completed successfully. The complication rate was 10%（ 2 /20） in the laparoscopic IPOM group.One patient developed hematoma and one patient developed intestinal leakage. While there were no complications such as infection,hematoma,intestinal leakage or chronic pain developed in the hybrid technique group. Compared with the patients who underwent the laparoscopic IPOM,there were no significant difference in bleeding [（ 68. 99 ± 23. 82） ml vs.（ 67. 22 ± 26. 59） ml,t = 0. 140,P =0. 890],the ambulation time [（ 2. 11 ± 0. 78） d vs.（ 2. 00 ± 0. 71） d,t = 0. 316,P = 0. 756],the hospital stay [（ 8. 44 ± 2. 01） d vs.（ 8. 22 ± 2. 49） d,t = 0. 209,P = 0. 837],postoperative pain score [1st day after operation：（ 5. 89 ± 1. 76） vs.（ 5. 78 ± 1. 48）,t =-0. 145,P = 0. 887,3rd day after operation：（ 3. 76 ± 0. 87） vs.（ 3. 11 ± 0. 93）,t =-1. 313,P = 0. 208]and dosage of analgesic [（ 4. 00± 1. 41） vs.（ 4. 11 ± 1. 54）,t =-0. 160,P = 0. 875] in the patients who underwent the hybrid technique. However there were marked differences in the mean operation time [（ 189. 44 ± 41. 50） min vs.（ 247. 78 ± 40. 55） min,t =-3. 016,P = 0. 008]. Conclusions： The hybrid technique is a safe and effective procedure for the abdominal incisional hernia repair compared with laparoscopic IPOM. It can shorten the operation time,moreover it can provide satisfactory short-term efficacy. So it is worthy of popularization.