腹壁切口疝修补手术的临床应用价值

Clinical application value of abdominal incisional hernia repair

目的探讨腹壁切口疝修补手术的临床应用价值。方法采用回顾性描述性研究方法。收集2013年1月至2017年12月武汉市第一医院收治的104例行腹壁切口疝修补手术患者的临床资料;男38例,女66例;年龄为(58±4)岁,年龄范围为31~85岁。患者均采取补片置入方式完成腹壁切口疝修补手术。观察指标:(1)术中情况。(2)并发症情况。(3)随访情况。采用电话问卷方式进行随访,了解患者术后复发情况。随访时间截至2019年6月。正态分布的计量资料以Mean±SD表示,偏态分布的计量资料以M(P25,P75)表示;计数资料以绝对数表示。结果(1)术中情况:104例患者顺利完成腹壁切口疝修补手术,手术时间为(111±18)min,术后住院时间为(6.1±2.4)d。104例患者中,行开放手术29例,行腹腔镜手术38例,行杂交手术37例。29例行开放手术患者中,腹壁缺损部位在脐下区(M4型)25例、胁腰部(L2型)2例、髂部(L3型)2例。29例行开放手术患者的补片放置于腹壁肌肉后。38例行腹腔镜手术患者中,腹壁缺损部位在剑突下(M1型)9例、上腹部(M2型)23例、肋缘下(L1型)6例。38例行腹腔镜手术患者的补片放置于腹膜腔内。37例行杂交手术患者中,腹壁缺损部位在脐部(M3型)27例、耻骨上区(M5型)10例。37例行杂交手术患者的补片放置于腹膜腔内。(2)并发症情况:29例行开放手术患者中,7例发生并发症,其中术后腹壁修补区域疼痛4例、切口愈合不良1例、修补区域浆液肿2例。38例行腹腔镜手术患者中,2例发生并发症,均为术后腹壁修补区域疼痛。37例行杂交手术患者中,6例发生并发症,其中切口愈合不良2例、修补区域浆液肿4例。104例患者中,6例术后腹壁修补区域疼痛患者,经局部封闭及镇痛治疗均缓解;3例切口愈合不良患者,经局部换药及二次清创缝合后愈合良好;6例修补区域浆液肿患者,经穿刺抽液及加压包扎后痊愈。无肠瘘、肠梗阻、腹腔间隔室综合征和死亡情况。(3)随访情况:104例患者均完成随访,随访时间为13个月(3个月,24个月)。104例患者中,术后6个月、13个月及16个月各复发1例。3例复发患者均经再次修补手术后痊愈出院。结论腹壁切口疝修补手术安全、有效,应根据术中具体情况选择合适的手术方式。

Objective To investigate the clinical application value of abdominal incisional hernia repair.Methods The retrospective and descriptive study was conducted.The clinical data of 104 patients who underwent abdominal incisional hernia repair in the Wuhan No.1 Hospital from January 2013 to December 2017 were collected.There were 38 males and 66 females,aged(58±4)years,with a range from 31 to 85 years.All patients underwent abdominal incisional hernia repair by patch implantation.Observation indicators:(1)intraoperative conditions;(2)complications;(3)follow up.Follow up by telephone questionnaires was performed to detect the postoperative recurrence up to June 2019.Measurement data with normal distribution were expressed as Mean±SD,measurement data with skewed distribution were expressed as M(P25,P75),and count data were expressed as absolute numbers.Results(1)Intraoperative conditions:all the 104 patients underwent the abdominal incisional hernia repair successfully.The operation time,duration of postoperative hospital stay were(111±18)minutes and(6.1±2.4)days.Among the 104 patients,29 underwent open surgery,38 underwent laparoscopic surgery,and 37 underwent hybrid surgery.Among the 29 patients undergoing open surgery,25 had defect area in the subumbilical region(M4 type),2 had defect area in the hypochondrial region(L2 type),and 2 had defect area in the ilium region(L3 type);all patients had patches placed in posterior muscle space.Among the 38 patients undergoing laparoscopic surgery,9 had subxiphoid defects(M1 type),23 had epigastric defects(M2 type),and 6 had subcostal defects(L1 type);all patients had patches placed in intraperitoneal cavity.Among the 37 patients undergoing hybrid surgery,27 had umbilical defects(M3 type)and 10 had suprapubic defects(M5 type);all patients had patches placed in intraperitoneal cavity.(2)Complications:among the 29 patients undergoing open surgery,7 had complications,including 4 of pain in the repaired area of abdominal wall,1 of poor wound healing,and 2 of seroma in the repaired area.Among the 38 patients undergoing laparoscopic surgery,2 were suffered from pain in the repaired area of abdominal wall.Among the 37 patients undergoing hybrid surgery,6 had complications,including 2 of poor wound healing and 4 of seroma in the repair area.Among the 104 patients,6 patients with pain in the repair area of abdominal wall after operation were improved by local closure and analgesic treatment;3 patients of poor wound healing were healed well after local dressing change and secondary debridement and suture;6 patients with seroma in the repaired area were cured by puncture,drainage and pressure bandage.No intestinal fistula,intestinal obstruction,abdominal compartment syndrome or death occurred.(3)Follow up:104 patients were followed up for 13 months(3 months,24 months).Among the 104 patients,1 recurred at 6 months,13 months and 16 months after operation,respectively.All the 3 patients were recovered and discharged after re repair.Conclusion Abdominal incisional hernia repair is safe and effective,which should be selected according to the specific conditions of the operation.