腹腔镜修补及开放式Onlay修补术在腹壁切口疝中的近期临床效果比较

目的比较腹腔镜修补及开放式Onlay修补术在腹壁切口疝的临床效果,探讨腹腔镜修补术在腹壁切口疝的安全性及可行性。方法 2012年8月~2018年12月我院肝胆外科收治的腹壁切口疝病人52例,其中Onlay组28例,采用Onlay修补法(肌鞘前的修补),腹腔镜组24例,采用腹腔镜修补法,比较两组手术时间、术中失血量、术后疼痛程度、术后并发症、术后恢复情况及炎症指标等。结果 (1)腹腔镜组的手术时间长于Onlay组,术中失血量少于Onlay修补组,差异有统计学意义(P<0.05);腹腔镜组术中肠管损伤2例,Onlay组肠管损伤4例,差异有统计学意义(P<0.05);(2)腹腔镜组术后12、24、48小时疼痛评分均低于Onlay组,差异有统计学意义(P<0.05);(3)腹腔镜组术后切口感染2例,不全性肠梗阻1例,共3例(12.50%)。Onlay组术后血清肿1例,切口感染4例,不全性肠梗阻各3例,共8例(28.57%)。两组病人术后均未出现肠漏。腹腔镜修补组并发症的发生率低于Onlay组,差异有统计学意义(P<0.05)。(4)腹腔镜组术后住院时间、下床活动时间短于Onlay修补组,住院费用高于Onlay组,差异有统计学意义(P<0.05);(5)两组术后12、24、48小时血清炎症因子指标(CRP、IL-6、PCT)比较,腹腔镜组均低于Onlay对照组,差异有统计学意义(P<0.05)。(6)术后随访6~48个月,两组复发率比较差异无统计学意义(P>0.05),腔镜组复发率腹(4.17%)略低于Onlay组(7.14%)。(7)术后随访6个月时,观察组各项生活质量评分均高于对照组,差异有统计学意义(P<0.05)。结论两种手术方式治疗腹壁切口疝均安全、有效。腹腔镜修补术治疗腹壁切口疝具有术后活动早、术后住院时间短、减轻术后炎症反应、改善术后生活质量、减少术后并发症及复发等优点。

Comparative study on laparoscopic repair and Onlay repair of recurrent incisional hernia

Objective To compare the clinical effects of two surgical methods in abdominal incisional hernia,and to explore the safety and feasibility of laparoscopic repair in abdominal incisional hernia.Methods The clinical data of 52 patients with incisional hernia of abdominal wall admitted to hepatobiliary surgery of our hospital from August 2012 to December 2018 were retrospectively analyzed.Among them,28 cases were treated with Onlay repair(pre-sheath repair)and 24 cases were treated with laparoscopic repair.The operation time,intraoperative blood loss,post-operative pain,post-operative complications and operation were compared and analyzed between the two groups.Posterior recovery and inflammatory markers.Results(1)The operation time of laparoscopic repair group was longer than that of Onlay repair group,and intraoperative blood loss was less than that of Onlay repair group(P<0.05),2 cases of intestinal injury in laparoscopic group and 4 cases of intestinal injury in Onlay group had statistical significance(P<0.05).(2)12,24,48 hours after operation,abdominal cavity.(3)2 cases of incision infection,1 case of incomplete intestinal obstruction and 3 cases of complications(12.50%)in laparoscopic repair group.In Onlay group,there were 1 case of seroma,4 cases of incision infection,3 cases of incomplete intestinal obstruction and 8 cases of complications(28.57%).There was no intestinal fistula after operation in both groups.The incidence of complications in laparoscopic repair group was lower than that in Onlay repair group(P<0.05).(4)The hospital stay and ambulation time in laparoscopic group were shorter than those in Onlay group(P<0.05).The cost of hospitalization was higher than that of Onlay repair group(P<0.05).(5)12,24,48 hours after operation,the serum inflammatory factors(CRP,IL-6,PCT)inlaparoscopic group were lower than that in Onlay control group(P<0.05).(6)After 6-48 months follow-up,there was no significant difference in recurrence rate between the two groups(P>0.05),but the recurrence rate in laparoscopic group(4.17%)was slightly lower than that in Onlay group(7.14%).(7)After 6 months follow-up,the quality of life scores of the observation group were higher than those of the control group(P<0.05).Conclusion Both methods are safe and effective in the treatment of incisional hernia of abdominal wall.Laparoscopic repair for abdominal incisional hernia has the advantages of early postoperative activity,short hospital stay and less complications.