腹腔镜腹壁疝修补术联合围手术期康复训练对成人腹壁疝患者术后胃肠功能恢复及复发的影响

目的探讨腹腔镜腹壁疝修补术联合围手术期康复训练对成人腹壁疝患者术后胃肠功能恢复及复发的影响。 方法分析2016年2月至2018年12月在北京怀柔医院就诊的80例腹壁疝患者，根据患者所采取的手术方法分为对照组和观察组，各40例。2组均采用腹腔镜内补片植入术，观察组无康复介入，治疗组采用术前1周、术后3周的康复训练，训练内容包括腹式呼吸训练、腹内外斜肌、腹横肌、多裂肌、盆底肌等核心肌群激活训练。记录手术相关指标及胃肠功能恢复指标；检测并比较2组治疗前后血清白细胞介素-6（IL-6）、C-反应蛋白（CRP）水平；统计术中及术后并发症；随访1年，观察疝复发率。 结果相较于对照组，观察组术后疼痛时间和下床活动时间均缩短（P<0.05），手术时间和术中出血量无明显差异（P>0.05）；观察组术后首次肠鸣音时间、肛门排气时间和首次排便时间均显著低于对照组（P<0.05）；术后2组IL-6和CRP水平均高于术前（P<0.05），但观察组IL-6和CRP水平低于对照组（P<0.05）；观察组尿潴留发生率低于对照组（P<0.05），2组患者的术中出血、肠管损伤、血清肿、慢性疼痛、复发率差异无统计学意义（P>0.05）。 结论腹腔镜腹壁疝修补术联合围手术期康复训练可促进成人腹壁疝患者术后胃肠功能恢复，降低机体炎性反应，且安全性高，降低术后复发率，具有较好的临床推广应用价值。

Effect of laparoscopic abdominal wall hernia repair combined with perioperative rehabilitation training on postoperative gastrointestinal function recovery and recurrence in adult patients with abdominal wall hernia

ObjectiveTo investigate the effect of laparoscopic abdominal wall hernia repair combined with perioperative rehabilitation training on the postoperative gastrointestinal function recovery and recurrence in adult patients with abdominal wall hernia. MethodsA retrospective analysis of 80 patients with abdominal wall hernia treated in Beijing Huairou hospital from February 2016 to December 2018 was divided into the control group and the observation group, with 40 cases in each group. Both groups were treated with intraperitoneal onlay mesh, and the control group was treated without perioperative rehabilitation training. The observation group received rehabilitation training on 1 week before and 3 weeks after the operation. The training included abdominal breathing training, and core muscles activation training (internal and external oblique muscles, transverse abdominis, multifidus muscle and pelvic floor muscle). Surgery-related indicators and gastrointestinal function recovery indicators were recorded, and serum interleukin-6 (IL-6) and C-reactive protein (CRP) levels were detected and compared between the two groups before and after treatment. The intraoperative and postoperative complications were followed. The recurrence of hernia was observed after 1 year follow-up. ResultsThe postoperative pain time and time to get out of bed in the observation group were lower than those in the control group (P<0.05). No difference of operation time and intraoperative blood loss was observed (P>0.05). The time of first bowel sounds, anal exhaust time, and time of first defecation in the observation group were lower than those in the control group (P<0.05). The levels of IL-6 and CRP in the two groups after the operation were higher than those before the operation (P<0.05), but the levels of IL-6 and CRP in the observation group were lower than those in the control group (P<0.05). The incidence of urinary retention in the observation group was lower than that in the control group (P<0.05), and there were no statistically significant differences in intraoperative bleeding, intestinal injury, seroma, chronic pain and recurrence rate between the two groups (P>0.05). ConclusionLaparoscopic abdominal wall hernia repair combined with perioperative rehabilitation training can promote gastrointestinal function recovery in adult patients with abdominal wall hernia, reduce inflammatory reactions in the body, and has high safety and low postoperative recurrence rate. It has a good clinical promotion value.