开放手术治疗中小型腹壁切口疝的临床研究

Clinical study of open surgery for small and middle abdominal wall incision hernia

目的探讨开放手术在治疗中小型腹壁切口疝手术中的应用价值。方法回顾性分析2016年1月—2018年1月郑州大学第一附属医院收治的110例中小型腹壁切口疝行疝修补术患者的临床资料,按手术方式不同分为开放组(n=57),腔镜组(n=53),开放组采用前入路腹膜外补片置入术行切口疝修补,腔镜组采用腹腔镜后入腹腔内补片置入术行切口疝修补。比较两组患者术后疼痛、胃肠功能恢复时间(排气、排便)、拔除胃管时间、拔除引流管时间、首次进食时间、住院时间、住院费用、术后不良反应及并发症发生率。计量资料以均数±标准差(Mean±SD)表示,组间差异比较采用t检验。计数资料组间比较采用χ^2检验。结果两组患者均康复出院。开放组术后1、3、5 d的疼痛视觉模拟评分(VAS)分别为(4.02±0.19)、(2.21±0.26)、(1.39±0.98)分,腔镜组分别为(4.68±0.62)、(2.76±1.18)、(1.84±0.62)分,开放组均小于腹腔镜组,两组相比差异均有统计学意义(P<0.05);开放组术后排气时间、排便时间、拔除胃管时间、拔除引流管时间、首次进食时间分别为(50.73±14.69)h、(87.21±13.75)h、(9.64±3.92)h、(3.42±1.22)d、(37.11±9.76)h,腔镜组分别为(65.14±9.54)h、(89.73±11.56)h、(11.43±5.61)h、(2.81±1.39)d、(38.92±7.59)h,两组相比差异均有统计学意义(P<0.05);开放组住院时间(9.14±0.03)d,腔镜组住院时间(9.74±0.49)d,两组相比差异无统计学意义(P>0.05);开放组住院费用(1.51±0.36)万元,腔镜组住院费用(2.13±1.06)万元,两组相比差异有统计学意义(P<0.05)。结论中小型腹壁切口疝采用开放式腹壁切口疝修补术安全有效,费用低,有利于减少患者痛苦,加速患者术后的恢复。

Objective To discuss the feasibility and value of open treatment for small and middle abdominal incision hernia repair.Methods Retrospective analysis of 110 patients with abdominal wall incision hernia repair in our hospital from January 2016 to January 2018.They were divided into two groups according to the different operation,including open treatment group(n=57)and laparoscopic treatment group(n=53),the VAS efficacy scores,anal exhaust time,defecating time,removal of gastric tube time,removal of drainage tube time,first feed time,postoperative hospital stay time,hospitalization expenses were observed and analyzed respectively,measurement date with normal distribution were expressed as(Mean±SD),comparisons between groups were analyzed using t test.Comparisons of count date between groups were analyzed using chi-square test.Results All the patients were discharged,the VAS efficacy scores in open treatment about one day or three day and five day were(4.02±0.19),(2.21±0.26),(1.39±0.98)scores,the VAS efficacy scores in laparoscopic treatment were(4.68±0.62),(2.76±1.18),(1.84±0.62)scores,there were differences in complications between the two groups(P<0.05).The anal exhaust time,defecating time,removal of gastric tube time,removal of drainage tube time,first feed time of open treatment group were(50.73±14.69)h,(87.21±13.75)h,(9.64±3.92)h,(3.42±1.22)d,(37.11±9.76)h,and the laparoscopic treatment group were(65.14±9.54)h,(89.73±11.56)h,(11.43±5.61)h,(2.81±1.39)d,(38.92±7.59)h,there were differences complications between the two groups(P<0.05).The postoperative hospital stay time of open treatment group were(9.14±0.03)d,the postoperative hospital stay time of laparoscopic treatment group were(9.74±0.49)d,there were not differences in complications between the two groups(P<0.05).The hospitalization expenses in open treatment group were(1.51±0.36)ten thousand yuan,the hospitalization expenses in laparoscopic treatment group were(2.13±1.06)ten thousand yuan,there were differencesin complications between the two groups(P<0.05).Conclusion Application of open treatment is feasible and effeetive for small and middle abdominal wall incision hernia.