杂交手术与腹腔镜下修补术治疗腹壁切口疝的临床研究

目的探讨杂交手术与腹腔镜下修补术治疗腹壁切口疝的临床体会。 方法回顾性分析2015年3月至2018年1月,苏州工业园区星湖医院普外科接受治疗的30例腹壁切口疝患者的临床资料。其中试验组患者14例,行杂交手术治疗;对照组患者16例,行腹腔镜下修补术。比较2组手术指标及术后疼痛情况。 结果试验组手术时间（175.63±21.15）min,与对照组（246.35±52.16）比较,差异有统计学意义（P<0.05）;试验组VAS评分、自主下床活动时间、术中出血量、住院时间、并发症发生情分别为（3.15±0.63）分、（2.49±0.35）d、（65.96±12.35）ml、（8.16±2.34）d及0,与对照组（3.65±0.52）分、（2.50±0.38）d、（66.34±13.52）ml、（8.26±2.18）d及2（12.5%）比较,差异均无统计学意义（P均>0.05）。 结论杂交手术治疗腹壁切口疝可明显缩短手术时间,且安全性好,具有较高的临床推广价值。     

腹横肌松解术在腹壁巨大切口疝修补中的临床应用

目的探讨腹横肌松解术（transversus abdominis muscle release,TAR）在治疗腹壁巨大切口疝中的临床效果。 方法回顾性分析2016年1月至2017年8月,杭州市第一人民医院集团收治的25例腹壁巨大切口疝患者的临床资料。 结果25例腹壁巨大切口疝患者中,其中男性16例,女性9例。平均年龄（65.0±11.4）岁,体质量指数（body mass index,BMI）为（31.15±5.83）kg/m²。平均腹壁缺损宽度（11.40±1.36）cm。22例为中线切口疝,3例为侧方切口疝。4例为复发性切口疝。所有患者均采用TAR＋后组织结构分离技术进行腹壁功能性重建,并采用肌后补片加强修补的手术方式。手术时间（152.0±31.6）min,术中出血量（116.8±44.1）cm³,住院时间（13.9±2.9） d。术后有2例出现浅表手术部位感染,4例Ⅲ型血清肿,1例不完全机械性肠梗阻,均经非手术治疗后治愈。无补片感染、肠瘘等并发症。随访期间未发现有复发、腹壁膨出病例。 结论腹横肌松解术＋后组织结构分离术是腹壁巨大切口疝治疗一种有效、安全的手术修补方法。     

肌后间隙修补法治疗腹壁切口疝患者的疗效

目的探讨肌后间隙修补法（Sublay）在腹壁切口疝患者治疗中的手术效果。 方法回顾性分析2015年1月至2017年8月,首都医科大学附属北京朝阳医院疝和腹壁外科107例行Sublay手术的腹壁切口疝患者的临床资料,分析患者的一般资料、手术方法、并发症及术后转归情况,随访其有无切口疝复发及补片相关并发症发生情况。 结果本组患者均顺利完成手术,平均手术时间（60.3±7.8）min,平均住院时间（17.6±5.3）d,所有患者术后恢复良好,2例患者出现脂肪液化,经换药后伤口愈合;1例患者出现皮下血肿,1例患者出现血清肿,经局部加压保守治疗后治愈,无伤口感染及局部异物感,无死亡患者。随访时间6～38个月,平均随访时间（22.7±10.8）个月,无切口疝复发,无死亡患者,无补片感染、慢性疼痛及局部异物感等补片相关并发症发生。 结论肌后间隙修补手术（Sublay）治疗腹壁切口疝结果满意,手术疗效较好。     

腹腔镜下腹腔内补片修补术治疗腹壁切口疝的临床研究

目的探讨腹腔镜下腹腔内补片修补术（IPOM）治疗腹壁切口疝的安全性及可行性。 方法回顾性分析2014-2019年中国人民解放军南部战区总医院对103例腹壁切口疝患者实施腹腔镜下IPOM的临床资料,观察其手术时间、术后排气时间、术后住院时间、并发症及复发情况。 结果103例患者均顺利完成手术,平均手术时间、术后排气时间及术后住院时间分别为（100±10）min、（40±8）h及（7.5±1.5）d。术中发现1例合并脐疝同时行脐疝修补,1例合并右侧腹股沟直疝同时行TAPP术,1例嵌顿性肠梗阻并肠坏死同时行肠切除吻合术。术后轻微并发症经短期治疗后痊愈,随访3~24个月,均无切口疝复发。 结论腹腔镜下IPOM治疗腹壁切口疝具有安全、有效、创伤小、可发现隐匿疝、术后康复快、能降低并发症、缩短住院时间、复发率低等优点。     

微小切口开放腹膜前手术在腹壁疝修补中的临床应用

目的探讨微小切口开放腹膜前（mini/less open sublay，MILOS）手术在腹壁疝修补中的临床应用和效果。 方法回顾性分析2016年11月至2018年6月，浙江大学医学院附属杭州市第一人民医院连续收治并接受MILOS手术修补的49例腹壁疝患者。 结果平均腹壁缺损宽度（5.27±2.95）cm，平均切口长度（4.89±2.13）cm。36例为切口疝，13例为脐疝（其中3例合并腹直肌分离症）。所有患者均采用MILOS手术完成修补，于肌后、腹膜前间隙放置补片，并放置密闭式负压引流管。平均手术时间（114.2±48.8）min，术中出血量（88.7±38.5）ml，住院时间（10.6±2.4） d。术后有2例（4.1%）浅表手术部位感染，1例（2.0%）Ⅲ型血清肿，均经非手术治疗后治愈。无肠梗阻、补片感染、肠瘘、慢性疼痛等并发症。随访期间未发现有复发、腹壁膨出病例。 结论MILOS手术是一种适应症较广的腹壁疝微创腹膜前修补方式，具有较高的临床应用价值。     

腹壁切口疝修补术后腹壁膨出相关因素研究

目的探讨腹壁切口疝术后腹壁膨出（bulging）及复发的发生率及其相关危险因素。 方法回顾性分析2008年1月至2017年12月,复旦大学附属华东医院行腹壁切口疝修补术治疗的774例患者临床资料,观察腹壁膨出及疝复发的发生率与临床病例因素的关系。 结果术后平均住院时间（8.15±2.60）d,随访时间3～78个月。术后腹壁膨出58例（7.49%）,患者体质量指数（BMI）、是否急诊手术、是否使用补片、补片放置层次、手术入路、是否关闭腹壁缺损等与腹壁切口疝修补术后腹壁膨出有关。 结论影响腹壁切口疝术后腹壁膨出发生的独立危险因素为BMI、是否急诊手术、是否使用补片、补片放置的层次、手术入路、是否关闭腹壁缺损。临床应加强术前病例的筛选,减少急诊手术的同时,严格控制患者体重,选择合适的手术方式和植入修补、确实关闭腹壁缺损,并加强术后切口管理,以预防和减少腹壁切口疝术后腹壁膨出的发生。     

老年患者腹壁切口疝修补术后复发的危险因素探讨及风险列线图模型的建立

目的探讨老年患者腹壁切口疝修补术后复发的危险因素，并建立预测老年患者腹壁切口疝修补术后复发的风险列线图模型。 方法选取2014年1月至2019年12月于南京大学附属鼓楼医院进行诊治的260例行腹壁切口疝修补术老年患者作为研究对象，分析所选患者的临床资料，根据是否复发将所选患者分为复发组和正常组，采用Logistic回归分析筛选老年患者腹壁切口疝修补术后复发的危险因素，并建立老年患者腹壁切口疝修补术后复发的风险列线图模型。 结果260例腹壁切口疝修补术老年患者中术后复发患者36例（13.85%）。单因素分析结果显示，复发组和正常组患者性别、年龄、疝类型、疝部位、补片型号、固定补片、手术类型及饮酒史等资料差异均无统计学意义（P>0.05），而手术时间、医师水平、术后血肿、吸烟史及肥胖等资料差异均有统计学意义（P<0.05）。Logistic回归分析结果显示，手术时间≥120 min、医师水平、术后血肿、有吸烟史及肥胖等为老年患者腹壁切口疝修补术后复发的独立危险因素（P<0.05），均和老年患者腹壁切口疝修补术后复发高度相关。基于手术时间、医师水平、术后血肿、吸烟史及肥胖等老年患者腹壁切口疝修补术后复发的独立危险因素，建立预测老年患者腹壁切口疝修补术后复发的风险列线图模型，C-index指数为0.775（95% CI：0.728~0.823），预测值与实测值基本一致，说明本列线图的辨别力较好，列线图模型预测老年患者腹壁切口疝修补术后复发的受试者工作特征曲线显示，曲线下面积为0.807，表明本研究列线图的预测价值较高。 结论手术时间≥120 min、医师水平、术后血肿、有吸烟史及肥胖等为老年患者腹壁切口疝修补术后复发的独立危险因素，本研究所建立的列线图有助于预测老年患者腹壁切口疝修补术后复发的发生风险。     

直接穿刺法建立第一穿刺孔及气腹在腹腔镜切口疝修补术中的应用

目的探讨腹腔镜切口疝修补术建立第一穿刺孔及气腹的临床经验。 方法回顾性分析2009年1月至2016年12月,中国人民解放军联勤保障部队920医院48例接受腹腔镜切口疝修补术患者的临床资料。 结果本组患者除4例中转外,其余患者均顺利完成手术。本组患者平均手术时间（157±90）min,术中平均出血（112±33）ml,术后平均住院时间（23±18）d。1例患者术后出现肠瘘,经保守治疗后治愈;另1例患者因肠粘连致肠梗阻,予以手术治疗后治愈。复发患者1例,再次于腹腔镜下修补,后患者无复发。本组患者建立第一穿刺孔及气腹过程中偶有腹壁血管损伤,无腹腔内肠管及重要血管损伤,术后无血清肿、慢性疼痛等。 结论无损伤可视套管直穿在腹腔镜切口疝修补术中建立第一穿刺孔及气腹比较安全、可靠。     

开放手术联合腹腔镜技术治疗腹壁嵌顿性或绞窄性切口疝11例疗效分析

目的 分析开放手术联合腹腔镜技术（杂交手术）修补嵌顿性或绞窄性切口疝的临床疗效。方法 回顾性分析2011年1月至2015年1月华中科技大学同济医学院附属武汉市中心医院疝与腹壁外科采用杂交手术治疗的11例嵌顿性或绞窄性切口疝病人的临床资料,并对病人术后进行随访。结果 所有病人均顺利完成手术,术后未见肠管损伤、心肺衰竭等严重并发症发生。手术时间为80～244（151.9±65.2）min,疝环缺损最大径为3～8（4.5±1.2）cm。10例病人为小肠嵌顿伴肠梗阻,1例病人为肠系膜嵌顿;4例病人术中证实为绞窄性切口疝,术中探查为小肠缺血坏死,体外行坏死小肠切除吻合;术中4例病人发现有隐匿性缺损存在。病人术后排便时间为3～9（4.1±2.2）d,4例病人术后早期出现明显腹胀症状,对症处理2～7 d后缓解。病人术后住院时间为7～18（11.7±3.6）d。术后随访12～36个月,中位随访时间为21个月,均未出现肠梗阻、迟发性补片感染、补片膨出及疝复发等并发症。结论 杂交手术修补嵌顿性或绞窄性切口疝具有一定的优势,值得临床推广应用。     

开放手术辅助腹腔镜与完全腹腔镜下修补术治疗腹壁切口疝的临床研究

目的探讨分析开放手术辅助腹腔镜与完全腹腔镜下修补术治疗腹壁切口疝的临床疗效和应用。 方法回顾性分析2016年1月至2018年6月在首都医科大学附属北京潞河医院普外科就诊并进行手术治疗的41例腹壁切口疝患者的临床资料。按照随机数字法表随机分为观察组和对照组。其中观察组20例,行开放手术辅助腹腔镜疝修补术;对照组21例,行完全腹腔镜下疝修补术。比较2组患者手术情况以及术后恢复、随访并发症情况。应用SPSS 21.0统计学软件进行数据处理。 结果观察组患者手术时间（106.81±33.90）min,术中出血量（14.05±7.85）ml,并发症发生1例（5%）;对照组分别为（126.75±23.36）min,（27.25±15）ml,3例（14.29%）,差异有统计学意义（P均<0.05）。观察组术后排气时间（2.05±0.51）d、住院天数（6.95±2.31）d,对照组分别为（1.71±0.64）d、（6.38±1.24）d,差异均无统计学意义（P均>0.05）。 结论开放手术辅助腹腔镜修补术治疗腹壁切口疝可明显缩短手术时间,减少术中出血,减少术后并发症的发生,效果显著,是一种安全有效的治疗方法。     

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??Hybrid technique for the repair of large complicated incisional hernia??Report of 28 cases YANG Bin, JIANG Zhi-peng, LI Ying-ru, et al. Department of Gastrointestinal Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
Corresponding author??CHEN Shuang??E-mail??sysusc@126.com
Abstract Objective To evaluate the operational skills and efficacy of a combined laparoscopic and open technique (hybrid technique) for the repair of large complicated incisional hernia. Methods The clinical data of 28 cases of large complicated incisional hernia underwent hybrid repair technique from September 2008 to February 2011 in Sun Yat-sen Memorial Hospital of Sun Yat-sen University were analyzed retrospectively. Results All cases were operated on successfully and recovered uneventfully. The operating time was 76-162 (102±21)min. The length of incision was 4-8 (6.1±0.8)cm. The diameter of the hernia ring was 10-25 (15.5±3.2)cm and the size of hernia ring was 64-224(118.0±42.1)cm2. Missed hernia was detected in 7 cases (25%) intraoperatively and was repaired during the procedure. Postoperative complications included abdominal pain (n=8, 28.6%), abdominal distension (n=3, 10.7%), seroma (n=2, 7.1%) and hematoma (n=1, 3.6%). All of them were cured with conservative treatment. Postoperative hospital time was 3-13 (4.9±1.8) days. No patient developed wound infection, massive haemorrhage, intestinal injury or cardiorespiratory function failure. One recurrent case was observed during a mean (25.1±5.6) months follow-up period. Conclusion Hybrid technique for incisional hernia repair is a safe and effective procedure especially suitable for patients with large complicated hernias, which deserves to be popularized.     

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??Therapeutic effect of hybrid technique for difficult incisional hernia repair LIANG Qing-yu??XIE Jia-ming??WU Hao-rong??et al. Department of General Surgery??the 2nd Affiliated Hospital of Soochow University??Suzhou 215004??China
Corresponding author??WU Hao-rong??E-mail??wuhaorong@vip.sina.com
Abstract Objective To investigate the safety and effectiveness of a hybrid technique for difficult incisional hernia repair. Methods The clinical and follow-up data of 10 cases of hybrid technique for incisional hernia repair performed from April 2011 to November 2013 at the 2nd Affiliated Hospital of Soochow University were analyzed retrospectively. Results All cases were performed by hybrid technique successfully with a mean operation time of ??181.9±68.2??min (120—330 min) and a mean time of postoperative hospital stay of??8.7±1.6??days (6—10 days). Seven cases started laparoscopically and were converted to open for dif?cult adhesiolysis. The other three cases were started as open procedures. Intraoperative findings showed two cases of incarcerated intestine and three cases of occult hernia. Abdominal wall pain occurred in four cases and all of them relieved basically in four weeks. All patients were followed up for??19.3±12.0??months (4—35 months). There was neither obvious seroma nor recurrence nor bulging. Conclusion The hybrid technique is safe and effective for difficult incisional hernia repair with less complication.     

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??Therapeutic effect of hybrid surgery for incarcerated or strangulated incisional hernia repair??An analysis of 11 cases LUO Wen??WANG Yong??DUAN Xin. Department of Hernia and Abdominal Surgery??the Central Hospital of Wuhan??Tongji Medical College Huazhong University of Science & Technology??Wuhan 430014??China
Corresponding author??WANG Yong??E-mail??rovine1984@sohu.Com
Abstract Objective To investigate the safety and effectiveness of a hybrid technique for incarcerated or strangulated incisional hernia repair. Methods The clinical and follow-up data of 11 cases of hybrid technique for incarcerated or strangulated incisional hernia repair performed from January 2011 to January 2015 in Department of Hernia and Abdominal Surgery??the Central Hospital of Wuhan??Tongji Medical College Huazhong University of Science & Technology were analyzed retrospectively. Results All cases were performed by hybrid technique successfully and without complications such as the injury of intestinal canal and cardiopulmonary failure after operations.We completed with a mean operation time of (151.9±65.2) min and found the diameter of the hernial ring of 3??8??4.5±1.2??cm. According to our statistics,10 cases of small bowel incarcerated with intestinal obstruction and 1 case of mesenteric incarcerated.4 cases of actually strangulation incision hernia with the small intestinal ischemic necrosis and were repaired in vitro.In addition,we found 4 cases of the occult hernial defects during the operation. The time of postoperative defecations was 3??9??4.1±2.2??d, and 4 cases of obvious symptoms of postoperative abdominal distension but recovered by treatment after 2 ~ 7d. All patients were followed up for 21(12??36) months. There was neither obvious seroma nor recurrence nor bulging. Conclusion The hybrid technique is safe and effective for incarcerated incisional hernia repair with less complication.     

腹腔镜切口疝修补术联合生物补片治疗巨大切口疝的疗效观察

目的探讨腹腔镜切口疝修补术联合生物补片治疗巨大切口疝的疗效。 方法回顾性分析2014年1月至2016年12月在中山大学附属第一医院接受腹腔镜切口疝修补术联合生物补片治疗的7例巨大切口疝患者的临床资料。 结果手术时间70～390 min。疼痛程度的视觉模拟评分在术后24 h、术后3 d及术后7 d分别为(4.8±0.69)分、(4.1±0.89)分、(3.9±1.10)分。术后肛门首次排气时间(2.2±0.95)d,术后住院时间(18.2±9.2)d。术后发热3例(42.9%,3/7),腹腔感染2例(28.6%,2/7),切口脂肪液化3例(42.9%,3/7),感染2例(28.6%,2/7),腹壁血清肿2例(28.6%,2/7),术后粘连性肠梗阻2例(28.6%,2/7),补片下积液2例(28.6%,2/7),肺部感染1例(14.3%,1/7)。所有患者获得随访,中位随访时间36个月;术后有腹壁慢性疼痛或不适感2例(28.6%,2/7),术后24个月复发1例(14.3%,1/7)。 结论腹腔镜切口疝修补术联合生物补片治疗巨大切口疝是安全有效的,但其长期疗效需要进一步观察。     

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??Hybrid technique in the treatment of the huge abdominal incisional hernia??An analysis of clinic therapeutic effect ZHU Yi-lin??CHEN Jie??SHEN Ying-mo??et al. Department of Hernia and Abdominal Wall Surgery??Beijing Chaoyang Hospital Affiliated to Capital University of Medical Sciences??Beijing 100020??China
Corresponding author??CHEN Jie??E-mail??zhshfbwkzz@yahoo.com.cn
Abstract Objective To analyze the clinical value of the hybrid technique in the treatment of the huge abdominal incisional hernia. Methods The clinical data of 347 cases of huge abdominal incisional hernia admitted form January 2008 to May 2013 in Department of Hernia and Abdominal Wall Surgery??Beijing Chaoyang Hospital Affiliated to Capital University of Medical Sciences were analyzed retrospectively. The operational course and the postoperative status among open (93 cases)??laparoscopic (152 cases) and the hybrid technique (102 cases) performed in huge abdominal incisional hernia were compared. Results The meantime of operation in the laparoscopic group???67.7±28.8??min?? was shortest and that in the hybrid group???103.1±30.6??min?? was longest. The length of incision in the hybrid groupp???8.2±4.0??cm?? was shorter than that in the open group???15.1±4.81??cm?? . The hospitalization stay in the open group and hybrid group was longer than that in the laparoscopic group. The follow-up ranged from 6 to 48 months. Twenty cases developed complication in the open group??30 in the laparoscopic group and 8 in the hybrid group. One case developed recurrence in the open group??1 in the laparoscopic group and none in the hybrid group. All the recurrent cases were cured by hybrid technique in 2 years after operation. Conclusion The hybrid technique is better than the other two in the treatment of the huge abdominal incisional hernia.     

腹膜腱膜瓣加强补片修补技术用于腹壁切口疝手术158例报告

目的 探讨腹膜腱膜瓣加强补片修补(FRAEM)技术在腹壁切口疝手术中的应用价值.方法 回顾性分析2017年9月至2020年6月复旦大学附属华东医院收治的158例采用FRAEM技术进行修补手术的腹壁切口疝病人的临床资料,观察围手术期及随访期内的指标,分析疗效.结果 158例病人均顺利完成手术,手术时间86～116(118...