“立体缝合”技术在腹腔镜巨大切口疝修补术中的应用疗效

Application efficacy of"multidimensional suture"technique in laparoscopic repair of giant incisional hernia

背景与目的:巨大切口疝的治疗是疝和腹壁外科领域的难点,尤其是如何缝合关闭筋膜缺损的问题。目前临床上常用的缝合方法应用于修补巨大切口疝中常面临诸多问题,如张力过大、无法消灭死腔等。基于缝合材料的发展,笔者团队前期开创了一种新的缝合技术—“立体缝合”,将其应用于切口疝修补中,可以很好地解决前述问题。本研究通过对比腹腔镜巨大切口疝修补术中应用“立体缝合”技术和常规缝合技术的两组患者的临床疗效,探讨“立体缝合”技术在巨大切口疝修补术中的临床价值。方法:回顾性分析2018年1月—2020年6月中山大学附属第六医院胃肠、疝和腹壁外科行腹腔镜腹腔内补片修补术的巨大切口疝患者资料,其中43例采用“立体缝合”处理疝囊和缺损(研究组),36例采用传统缝合方法关闭缺损(对照组),比较两组患者的相关临床指标。结果:研究组无中转开放病例,均实现了筋膜缺损的完全关闭,对照组中转开腹7例(19.44%),无法完全关闭缺损5例(13.89%);两组中转开放率与无法完全关闭缺损发生率差异有统计学意义(P=0.003,P=0.017)。研究组平均关闭筋膜缺损缝合时间(89.84±15.29)min,平均手术时间(181.51±18.23)min,平均术中出血量(26.84±12.67)mL,对照组平均关闭筋膜缺损缝合时间为(61.28±14.09)min,平均手术时间(157.72±19.17)min,平均术中出血量(27.25±11.83)mL,两组关闭筋膜缺损缝合时间及手术时间差异有统计学意义(均P<0.001),出血量差异无统计学意义(P=0.871)。研究组术后手术部位事件(SSO)发生率明显低于对照组(2.33%vs.16.77%,P=0.043),两组术后复发率差异无统计学意义(0 vs.2.8%,P=0.456)。研究组术后下床时间(22.36±4.45)h,术后住院时间(5.23±1.26)d,住院费用为(75924.21±6065.61)元,对照组术后下床时间(22.92±5.15)h,术后住院时间(5.46±1.93)d,对照组为(74185.99±5476.48)元,两组该3项指标差异均无统计学意义(P=0.192,P=0.440,P=0.283)。结论:“立体缝合”技术应用于巨大切口疝修补术中,可减少中转开腹发生率,有效关闭筋膜缺损,减少术后发生手术部位事件的风险。

Background and Aims:The repair of giant incisional hernia is a difficult surgical procedure in the practice of hernia and abdominal wall surgery,especially for the problem of suture and closure of the fascia defect.At present,the suture method commonly used in clinical practice is often faced with many problems in repairing giant incisional hernia,such as excessive tension and unobliterated dead space.Based on the development of suture materials,the authors'team has previously developed a new suture technique-"multidimensional suture",and use of this technique in incisional hernia repair can effectively solve the above problems.This study was performed to demonstrate the clinical value of"multidimensional suture"technique in giant incision hernia repair by comparing its clinical efficacy with that of conventional suture technique in laparoscopic repair of large incisional hernia.Methods:The data of patients with giant incisional hernia who underwent laparoscopic intraperitoneal onlay mesh repair for giant incision hernia in the Department of Gastrointestinal and Hernia Surgery,the Sixth Affiliated Hospital of Sun Yat-sen University from January 2018 to June 2020 were retrospectively analyzed.Of the patients,43 cases received“multidimensional suture”for the treatment of hernia sac and defect(study group),and 36 cases underwent the conventional suture method for the closure of defect(control group).The main clinical variables were compared between the two groups of patients.Results:No open conversion was needed and the fascia defects were completely closed in all patients in study group,while,7 patients(19.44%)were converted to open surgery and complete defect closure failed in 5 patients(13.89%)in control group.The open conversion rate and incidence of failed complete defect closure were significantly different between the two groups(P=0.003,P=0.017).The average time of fascia defect closure,the average operative time and the average intraoperative blood loss were(89.84±15.29)min,(181.51±18.23)min,and(26.84±12.67)mL for study group,and were(61.28±14.09)min,(157.72±19.17)min,and(27.25±11.83)mL for control group,respectively.The difference between the two groups had statistical significance in time of fascia defect closure and operative time(both P<0.001),and had no statistical significance in intraoperative blood loss(P=0.871).The incidence of postoperative surgical site occurrences(SSO)in study group was significantly lower than that in control group(2.33%vs.16.77%,P=0.043),while there was no statistical difference in postoperative recurrence rates between two groups(0 vs.2.78%,P=0.456).The postoperative time to ambulation,the length of postoperative hospital stay and hospitalization cost were(22.36±4.45)h,(5.23±1.26)d,and(75924.21±6065.61)yuan for study group,and(22.92±5.15)h,(5.46±1.93)d,and(74185.99±5476.48)yuan for control group,respectively.No significant differences in these 3 variables were noted between the two groups(P=0.192,P=0.440,P=0.283).Conclusion:The application of"multidimensional suture"technique in giant incision hernia repair can decrease the conversion rate to open surgery,effectively close the fascia defect,and reduce the risk of postoperative surgical site occurrence.