腹壁切口疝的外科治疗体会

Investigation on surgical treatment of abdominal incisional hernia

目的总结腹壁切口疝手术治疗的方式与体会。方法选取2005年1月至2014年12月新疆维吾尔自治区人民医院微创、疝与腹壁外科收治的722例切口疝患者临床资料,对患者BMI、腹壁切口疝的分类、术前有无伤口感染、手术方式和术后随访情况进行回顾性分析。结果本组病例中77例未行手术,645例手术均获成功;504例行开腹切口疝修补术,其中372例使用补片修补(Sublay修补法67例,Onlay修补法275例,Inlay修补法30例),132例行传统缝合修补;135例行腹腔镜疝修补术,6例行杂交手术。手术时间55~150 min,平均时间85 min,无手术死亡病例;患者术后8~24 h后下床活动,1~2 d排气,术后疼痛轻,2~3 d后完全缓解,术后3~10 d(平均7 d)患者顺利康复出院。随访1~93个月,随访率97.2%。结论在临床工作中,应根据腹壁切口疝患者的机体状况、腹壁缺损大小、BMI、术前有无伤口感染个体化治疗腹壁切口疝。

Objective Summarize the methods and experience of surgical treatment for incision hernia of abdominal wall. Methods A retrospective analysis was conducted on 722 incision hernia patients who were admitted to Xinjiang Uygur Autonomous Region People’ s Hospital during January 2005 and December 2014. The BMI,hernia classification,preoperative sign of wound infection,surgical procedure and postoperative follow-up were viewed. Results Of these 722 patients,there were 77 patients who didn’t have surgical repair,the rest 645 operations were successfully completed. 504 patients had open incisional hernia repair,and 372 of them underwent patch repair（ 67 cases of Sublay repair,275 Onlay repair,and30 Inlay repair）; 132 people were performed withprimary suture repair; 135 patients underwent laparoscopic hernia repair,and 6 patients underwent hybridization operation. Operation time was 55 to 150 minutes,an average of 85 minutes,without death cases. Patients return to ambulation after 8 to 24 hours,and had fart in 1 to 2 days. The postoperative pain is mild,and showed complete relief after 2 to 3 days. Patients were discharged from hospital in 3 to 10 days after surgery（ an average of 7 days）. With a Follow-up of 1 to 93 months,the follow-up rate was 97. 2%. Conclusion In clinical practice,an individualized treatment should be performed for the incision hernia patients,depending on medical condition,defect size,BMI,and preoperative presence of wound infection.