腹壁切口疝术式选择的单中心回顾性研究

Single-center retrospective study of surgical methods used to repair abdominal incisional hernias

目的 比较肌前补片修补(Onlay)、肌后补片修补(Sublay)、腹腔镜下腹腔内补片植入术(IPOM)在腹壁切口疝修补中的临床疗效及优缺点。方法 回顾性分析118例腹壁切口疝患者的临床资料,其中IPOM组83例、Sublay组22例、Onlay组13例,比较3组患者术前一般临床资料、术中出血量、手术时间、疝环最大直径、住院时间、住院总费用、术后并发症等临床参数。结果 3组比较,疝环最大直径、住院时间和住院总费用有统计学差异(P <0.05),IPOM组住院时间最短,住院总费用最多,Onlay组和Sublay组疝环最大直径明显大于IPOM组(均P <0.001)。随访6~45个月,3组均未见复发。结论 IPOM费用高,但能够明显缩短术后住院时间,并降低术后感染发生率。Onlay对于巨大切口疝患者安全、可行,适用于腹腔内粘连十分严重、腹膜前间隙分离困难的患者。在充分关闭肌筋膜的前提下进行Onlay三圈缝合法,可以获得与Sublay相似的效果。

Objective To compare the clinical efficacy,advantages,and disadvantages of open Onlay,open Sublay,and laparoscopic intraperitoneal Onlay mesh(IPOM) techniques for the repair of abdominal incisional hernia. Methods The clinical data of 118 patients with abdominal incisional hernia were analyzed retrospectively,including 83 in the IPOM group,22 in the Sublay group,and 13 in the Onlay group. The preoperative general clinical data,intraoperative blood loss,operation time,maximum diameter of hernia ring,length of hospital stay,total hospitalization cost,postoperative complications,and other clinical parameters were compared among the three groups.Results There were significant differences in the maximum diameter of hernia ring,length of hospital stay,and total hospitalization cost among the three groups(P < 0.05). The length of hospital stay was significantly shorter in the IPOM group than in other two groups(P <0.001). The maximum diameter of hernia ring was significantly larger in the Onlay and the Sublay groups(P < 0.001) than in the IPOM group. During 6-45 months of follow-up,there was no recurrence of hernia among the three groups. Conclusion The laparoscopic IPOM technique is expensive;however,it can significantly shorten the length of hospital stay and reduce the incidence of postoperative infections. The open Onlay technique is safe and feasible for patients with huge incisional hernia. It is applicable to patients with severe intraperitoneal adhesion and in situations of difficulty in separating the preperitoneal space. On the premise of fully closing the myofascia,the open Onlay technique using the three-loop pully suture can achieve the same efficacy as the open Sublay technique.