“对位对线”补片固定法在腹腔镜切口疝修补术中的应用

背景与目的 切口疝的微创修补理念在疝外科界已经形成共识，腹腔镜下切口疝修补在临床上的应用越来越普及，但腔镜下的补片固定技术仍然是一个难点。本研究旨在介绍一种新式的切口疝补片固定方法并探讨其临床应用效果。方法 回顾性分析2018年1月—2019年12月中山大学附属第六医院胃肠、疝和腹壁外科120例行腹腔镜切口疝修补手术（IPOM）患者的临床资料，其中60例的补片固定方式采用“对位对线”补片固定法（观察组），另60例采用传统疝钉双圈固定方法（对照组），比较两组患者相关临床指标以及经济学指标。结果 两组患者性别、年龄、BMI、病程以及疝环最大缺损指标差异均无统计学意义（均P>0.05）。观察组的平均补片固定时间短于对照组（35.5 min vs. 47.7 min，P<0.05），平均疝钉固定数量少于对照组（36.6枚 vs. 44.2枚，P<0.05），平均术后疼痛VAS评分低于对照组（3.2分 vs. 4.6分，P<0.05），住院费用低于对照组（3.9万元 vs. 4.8万元，P<0.05）。两组患者在血清肿、补片感染发生率，术后住院时间的差异均无统计学意义（均P>0.05）。观察组和对照组平均随访26.3个月与25.8个月，观察组和对照组的切口疝复发率（1.7% vs. 5.0%，P=0.61）及术后慢性疼痛的发生率差异均无统计学意义（6.7% vs. 8.3%，P=1.00）。结论 “对位对线”补片固定法可缩短补片固定时间，减少疝钉使用数量，节约住院费用，并且可降低切口疝术后早期疼痛的发生，该方法在腹腔镜切口疝修补术中的应用是安全有效的，可在临床进行推广使用。

Application of "contraposition and alignment" mesh fixation in laparoscopic incisional hernia repair

Background and Aims The concept of minimally invasive repair of incisional hernia has reached a certain consensus in the field of hernia surgery. Laparoscopic incisional hernia repair is becoming more popular in clinical practice, but endoscopic mesh fixation technique is still a difficult issue. This study was to introduce a new method of incisional hernia mesh fixation and evaluate its clinical application effect.Methods The clinical data of 120 patients undergoing laparoscopic incisional hernia repair (IPOM) in the Department of Gastroenterology, Hernia and Abdominal Wall Surgery of the Sixth Affiliated Hospital of Sun Yat-sen University from January 2018 to December 2019 were retrospectively analyzed. Of the patients, the "contraposition and alignment" mesh fixation was used as the mesh fixation method in 60 cases (observation group), and the traditional mesh fixation method of double-crown tacker fixation was used in the other 60 cases (control group). The relevant clinical variables and economic indexes of the two groups were compared.Results There were no significant differences in gender, age, BMI, course of disease and the maximum diameter of the defect of the hernia between the two groups (all P>0.05). Compared with control group, the mean mesh fixation time was shortened (35.5 min vs. 47.7 min, P<0.05), the mean number of hernia tackers used for fixation was decreased (36.6 vs. 44.2, P<0.05), the mean VSA score of postoperative pain was lowered (3.2 vs. 4.6, P<0.05), and the hospitalization cost was reduced (39 000 yuan vs. 48 000 yuan, P<0.05) in observation group. There were no significant differences in incidence rates of seroma formation and mesh infection as well as the length of postoperative hospital stay between the two groups (all P>0.05). The average follow-up time for observation group and control group were 26.3 and 25.8 months, respectively. No significant differences were noted between observation group and control group in recurrence rate of incisional hernia (1.7% vs. 5%, P=0.61) and the incidence of postoperative chronic pain (6.7% vs. 8.3%, P=1.00).Conclusion The "contraposition and alignment" mesh fixation could shorten the mesh fixation time, reduce the number of hernia, save hospitalization costs, and reduce the occurrence of early postoperative pain after incisional hernia. The application of this method in laparoscopic incisional hernia repair is safe and effective, and can be widely used in clinical practice.