应用猪小肠黏膜下层脱细胞基质补片行腹壁切口疝修补术19例疗效观察

Evaluation of porcine small intestinal submucosa acellular matrix patch for incisional hernia repair

目的探讨猪小肠黏膜下层(SIS)脱细胞基质补片(以下简称SIS补片)在腹壁切口疝修补术中应用的安全性和有效性。方法回顾性分析2012-03-01—2017-03-31中山大学附属第一医院应用SIS补片行腹壁切口疝修补术的19例病人临床资料。结果 19例病人中,男性5例(26.3%),女性14例(73.7%),男女比1∶2.8;中位年龄67(38~81)岁;BMI(27.7±2.2)。手术中位时间170(65~390)min;术中测量疝环长径中位长度为8(3~20)cm,中位宽度为7(3~15)cm。本组清洁手术14例(73.7%),潜在污染手术4例(21.0%),污染手术1例(5.3%)。术后24 h、术后第3天、术后第7天病人疼痛数字评分(NRS)分别为5.1±0.8、4.2±0.7、3.6±0.8。术后肛门首次排气时间为(2.2±0.8)d。本组病人在围术期无死亡病例,中位住院时间18(4~50)d。术后总并发症发生率为52.6%(10/19),包括发热(26.3%,5/19),切口并发症(47.4%,9/19),腹腔感染(21.1%,4/19),肠梗阻(21.1%,4/19),肺部感染(10.5%,2/19),急性心肌梗死(5.3%,1/19)。术后7例病人复查CT,其中5例存在不同程度的补片下积液,2例合并感染。Clavien-Dindo并发症分级0级9例(47.4%)、1级2例(10.5%)、2级6例(31.6%)、3级1例(5.3%)、4级1例(5.3%)。术后随访率为94.7%(18/19),中位随访时间26.6(8.0~60.0)个月。术后2例(11.1%,2/18)病人因其他疾病死亡;腹壁慢性疼痛或不适者占26.3%(5/18);26.3%(5/18)病人出现切口疝复发,中位复发时间为12(1~24)个月。结论 SIS补片能安全有效运用于腹壁切口疝修补术中,且能够安全应用于潜在污染或污染手术区域中,但具有较高并发症发生率和疝复发率,其长期疗效仍须进一步观察。

Objective To evaluate the safety and efficacy of porcine small intestinal submucosa acellular matrix patch for incisional hernia repair. Methods From March 1, 2012 to March 31, 2017, the clinical data of 19 cases of incisional hernia underwent herniorrhaphy by porcine small intestinal submucosa acellular matrix patch in the First Affiliated Hospital of Sun Yat-Sen University were analyzed retrospectively. Results There were 5 cases （26.3%） of male patients and 14 cases （73.7%） of female patients in the total 19 cases. The ratio of male and female was 1∶2.8. The median age was 67（from 38 to 81） years old. The average BMI was 27.7± 2.2. The median operative time was 170（from 65 to 390）minutes. The median length and width of hernia ring measured in operation were 8 （from 3 to 20） centimeters and 7（from 3 to 15） centimeters respectively. There were 14 cases （73.7%） of clean surgery, 4 cases （21.0%） of potential contaminative surgery and 1 case （5.3%） of contaminative surgery. The numerical rating scale （NRS） of pain on the 24 hours,third and seventh day after the operation were 5.1±0.8, 4.2±0.7 and 3.6±0.8 respectively. The first exhaust time after operation was 2.2±0.8 days. There was no death during perioperative time. The median hospitalization time was 18 （from 4 to 50） days. The incidence of postoperative complications was 52.6% （10/19）. The complications included： fever （26.3%,5/19）,incisional complications （47.4%, 9/19）, abdominal infection （21.1%,4/19）,intestinal obstruction（21.1%,4/19）,pneumonia （10.5%,2/19）, acute myocardial infarction（5.3%,1/19）.Seven patients were reviewed for CT after operation, of which 5 cases had different degrees of effusion under the patch and 2 were infected. According to the Clavien-Dindo classification, from zero to fourth level were 47.4% （9/19）, 10.5% （2/19）, 31.6% （6/19）, 5.3% （1/19）, and 5.3% （1/19） respectively. The follow-up rate was 94.7% （18/19） and the median time were 26.6（from 8.0 to 60.0） months. Two patients （11.1%, 2/18） died after the operation due to other diseases. Chronic abdominal pain or discomfort accounted for 26.3% （5/18）. The recurrence ratio of incisional hernia was 26.3% （5/18） and its median time was 12 （from 1 to 24） months. Conclusion Porcine small intestinal submucosa acellular matrix patch can be used safely and effectively in the repair of incisional ventral hernia, especially in the infected or potentially contaminated surgery. But it has high complication rate and hernia recurrence rate. Obviously, long-term follow-up is still required.