腹腔镜联合开腹补片修补术对巨大切口疝及肠黏连紧密腹壁切口疝患者临床研究

Clinical study of laparoscopic combined with open mesh repair on patients with giant incisional hernia and intestinal adhesions

目的分析腹腔镜结合开腹补片修补术对腹部切口疝患者治疗效果。方法回顾性分析湖北省肿瘤医院肝胆胰外科自2011年2月至2018年2月收治的腹壁切口疝患者133例,其中62例行开腹补片修补术为对照组,余71例行腹腔镜结合开腹补片修补术为观察组;观察患者手术状况、术后恢复状况,术后1d采用ELISA法检测血清氧化应激指标,包含胰岛素(InS)、β-内啡肽(β-EP)、生长激素(GH)和总抗氧化能力(T-AOC)含量,术后对患者随访1年,记录患者术后并发症和复发率情况。结果观察组患者术中失血量低于对照组,差异有统计学意义(P<0.05);观察组患者术后下床活动时间、肠功能恢复时间、首次进食时间、肠鸣音恢复时间及住院时间均低于对照组,差异有统计学意义(P<0.05);术后1 d观察组患者血清InS、GH及T-AOC含量高于对照组,β-EP含量低于对照组,差异有统计学意义(P<0.05);观察组患者并发症发生率低于对照组,差异有统计学意义(P<0.05)。结论腹腔镜联合开腹补片修补术对巨大切口疝及肠黏连紧密腹壁切口疝患者疗效显著,患者创伤小、术后恢复快,且术后并发症发生率和复发率降低。

Objective To analyze the therapeutic effect of laparoscopic combined with open mesh repair on patients with abdominal incisional hernia.Methods A retrospective analysis of 133 patients with abdominal incisional hernia treated in Hubei Cancer hospital from February 2011 to February 2018,62 patients underwent open mesh repair,as a control group,the remaining 71 patients underwent laparoscopic surgery combined with open mesh repair,as an observation group;observe the patient's surgical status,postoperative recovery,at 1st day after surgery detect serum oxidative stress indicators,including insulin(InS),β-endorphin(β-EP),levels of growth hormone(GH)and total antioxidant capacity(T-AOC).The patients were followed up for 1 year.The postoperative complications and recurrence rate were recorded.Results The blood loss of the observation group was lower than that of the control group(P<0.05).The time of getting out of bed,the recovery time of bowel function,the first feeding time,the recovery time of bowel sounds and the hospital stay in observation group was lower than those in the control group(P<0.05).The serum levels of InS,GH and T-AOC in the observation group were higher than those in the control group,and theβ-EP content was lower than the control group,with statistical significance(P<0.05);the incidence of complications in the observation group was lower than that in the control group(P<0.05).Conclusion Laparoscopic combined with open mesh repair is effective in patients with giant incisional hernia and intestinal adhesions.The patients have small trauma,rapid recovery,and the postoperative complications and recurrence rate are reduced.