腹腔镜完全腹膜外补片与腹腔内补片治疗两侧下腹壁切口疝的临床对比观察

Clinical comparison of laparoscopic complete peritoneal patch and intraperitoneal patch in the treatment of bilateral lower abdominal wall incisional hernia

目的:探讨两侧下腹壁切口疝患者行腹腔镜完全腹膜外补片修补术(TES)与腹腔镜腹腔内补片修补术(IPOM)的应用效果及安全性。方法:选取2019年2月至2022年2月80例两侧下腹壁切口疝患者作为研究对象,按数字表法将患者分为对照组与观察组,每组各40例,对照组患者行IPOM,观察组患者行TES。采用SPSS 24.0统计软件分析数据,手术相关指标、疼痛VAS评分等计量资料以(^(-)x±s)表示,行独立样本t检验;术后并发症发生率等计数资料以[例(%)]表示,采用χ^(2)检验。以P<0.05为差异有统计学意义。结果:观察组患者比对照组手术用时长、术中出血量多、住院费用低,差异有统计学意义(P<0.05);观察组患者术后1 d、3 d、7 d的VAS评分较对照组低(P<0.05);观察组患者术后远期并发症(慢性疼痛、慢性不全性肠梗阻、肠瘘、疝复发)发生率(7.5%)明显低于对照组(25.0%)(P<0.05);两组患者近期并发症发生率比较,差异无统计学意义(P>0.05)。结论:TES与IPOM治疗两侧下腹壁切口疝,均可取得良好的治疗效果,其中TES在减轻术后疼痛、降低术后远期并发症、减少住院费用方面优势更为突出,但手术操作相对复杂,手术用时长。

Objective To investigate the efficacy and safety of laparoscopic complete peritoneal patch repair(TES)and laparoscopic intraperitoneal patch repair(IPOM)in patients with bilateral lower abdominal incisional hernia.Methods Eighty patients with bilateral lower abdominal incisional hernia from February 2019 to February 2022 were selected as the study objects,and the patients were divided into control group and observation group according to digital table method,with 40 cases in each group.Patients in the control group received IPOM,and patients in the observation group received TES.SPSS 24.0 statistical software was used to analyze the data.Surgical indicators,pain VAS score and other measurement data were expressed as(^(-)x±s),and independent sample t test was performed.The statistical data such as the incidence of postoperative complications were presented by[n(%)]andχ^(2)test was used.P<0.05 was considered to be statistically significant.Results The operation duration,intraoperative blood loss and hospitalization cost in observation group were higher than those in control group,with statistical significance(P<0.05).VAS scores of observation group at 1,3 and 7 days after operation were lower than those of control group(P<0.05).The incidence of postoperative long-term complications(chronic pain,chronic incomplete intestinal obstruction,intestinal fistula,hernia recurrence)in observation group(7.5%)was significantly lower than that in control group(25.0%)(P<0.05).There was no significant difference in the incidence of recent complications between the two groups(P>0.05).Conclusion Both TES and IPOM can achieve good therapeutic effects in the treatment of bilateral lower abdominal incisional hernia,among which TES has more prominent advantages in alleviating postoperative pain,reducing postoperative long-term complications and reducing hospital costs,but the surgical operation is relatively complex and the operation time is long.