83例腹壁切口疝手术治疗临床经验总结

Summary of clinical experience of 83 cases abdominal incisional hernia surgery

目的比较腹腔镜腹壁切口疝修补术与开腹腹壁切口疝修补术的临床疗效差异,并探究切口疝复发原因。方法收集我院2011—2016年因腹壁切口疝行手术治疗患者的一般临床资料,根据手术方式将患者分为腹腔镜组(n=21,采用腹腔镜腹壁切口疝修补术)与开腹组(n=62,采用开腹腹壁切口疝修补术)。比较两组患者手术疗效,并分析腹壁切口疝复发的可能原因。结果腹腔镜组患者的术中出血量少于开腹组,术后住院时间短于开腹组,住院总费用高于开腹组(P<0.05)。对所有患者进行随访,其中有10位患者复发。单因素分析显示,多次腹部手术病史和复发疝是切口疝术后复发的危险因素(P<0.05)。多因素分析显示,复发疝为切口疝术后复发的独立危险因素(P<0.05)。结论腹腔镜腹壁切口疝修补术疗效与开腹腹壁切口疝修补术无明显差异,但其可缩短患者术后住院时间、减少术中出血量,值得进一步推广应用。

Objective To compare the clinical effects of laparoscopic incisional hernia repair and open incisional hernia repair,and to explore the causes of recurrence of incisional hernia.Methods The general clinical data of patients with abdominal incisional hernia who underwent surgical treatment in our hospital from 2011 to 2016 were collected.According to the surgical methods,the patients were divided into laparoscopic group(n=21,given laparoscopic incisional hernia repair)and open group(n=62,given open incisional hernia repair).The curative effects of the two groups were compared,and the possible causes of recurrence of abdominal incisional hernia were analyzed.Results The intraoperative bleeding volume in the laparoscopic group was less than that in the open group,the hospitalization time after operation was shorter than that in the open group,and the total cost of hospitalization in the laparoscopic group was higher than that in the open group(P<0.05).All patients were followed up and 10 cases of them reoccured.The univariate analysis showed that multiple abdominal operations and recurrent hernia were risk factors for recurrence after incisional hernia surgery(P<0.05).The multivariate analysis showed that recurrent hernia was the independent risk factor for recurrence after incisional hernia surgery(P<0.05).Conclusion Laparoscopic incisional hernia repair has no significant difference from open incisional hernia repair,but it can shorten the hospitalization time and reduce the amount of intraoperative bleeding,which is worthy of further promotion and application.