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。

The effect of laparoscopic herniorrhaphy combined with biological mesh in the treatment of giant incisional hernia

ObjectiveThe purpose of this article is to explore the therapeutic effect of laparoscopic hernia repair combined with biological patch in the treatment of giant incisional hernia. MethodsThe clinical data of seven patients with giant incisional hernia treated by laparoscopic incisional hernia repair combined with biological patch in our hospital from Jan. 2014 to Dec. 2016 were analyzed retrospectively. ResultsThe operation time was from 70-390 minutes. The VAS pain scores on 24 hours operatively, POD3 and POD7 were(4.8±0.69), (4.1±0.89) and (3.9±1.10) respectively. The postoperative anal exhaust time was (2.2±0.95)days. The average postoperative hospitalization time was (18.2±9.2)days. The postoperative complications included three cases of fever (42.9%, 3/7), two cases of abdominal infection (28.6%, 2/7), three cases of fat liquefaction of incision (42.9%, 3/7), two cases of wound infection (28.6%, 2/7), two cases of abdominal wall seroma (28.6%, 2/7), two cases of adhesive intestinal obstruction after operation (28.6%, 2/7), two cases were filled by effusion (28.6%, 2/7), one case of pulmonary infection (14.3%, 1/7). All patients were followed up for an average of 36 months. Postoperative abdominal pain or discomfort occurred in two cases (28.6%, 2/7), and one case(14.3%, 1/7) recurred 24 months after operation. ConclusionsLaparoscopic herniorrhaphy combined with biological patch is safe and effective for the treatment of huge incisional hernia, but its long-term effect needs further observation.