腹腔镜与开放式无张力修补术治疗腹壁疝临床对比研究

目的 评价腹腔镜腹壁疝修补术（LVHR）的安全性与有效性。方法 对2007年1月至2008年8月间上海交通大学医学院附属瑞金医院接受无张力修补术的68例腹壁疝病人（缺损长径≤20cm）的临床资料进行回顾性分析。结果 LVHR 31例，开放式腹壁疝修补术（OVHR）37例。随访时间1～21个月（中位时间11个月）。LVHR与OVHR在年龄、性别比、BMI和疝缺损大小上差异无统计学意义（P>0.05）。LVHR与OVHR的平均手术时间分别为（60.5±17.7）min和（75.5±30.3）min（P＝0.017），平均术后住院天数分别为（6.2±2.5）d和（9.6±8.0）d（P＝0.026），术后2周内恢复非限制性活动人数分别为96.8%和78.4%（P=0.026），差异均有统计学意义。两组术后第1天的疼痛评分VAS分别为5.6±1.2和6.3±1.3，差异有统计学意义（P＝0.018），术后1周和1个月的VAS差异无统计学意义（P＝0.932，P＝0.056）。两组总并发症发生率分别为19.4%和24.3%（P =0.623），复发率分别为3.2%和5.6%（P =1.000），差异无统计学意义。两组的住院总费用分别为（18334±5336）元和（9508±9222）元，差异有统计学意义（P =0.000）。结论 LVHR对于缺损长径<20cm的腹壁疝是安全有效的。

Clinical control study of laparoscopic procedures vs open mesh repair for ventral hernias

Clinical control study of laparoscopic procedures vs open mesh repair for ventral hernias LI Jian-wen, XIE Yi-sheng, QIU Ming-yuan, et al. Department of General Surgery, Ruijin Hospital of Shanghai Jiao Tong University, Shanghai Minimally Invasive Surgery Centre, Shanghai 200025, China. Correspongding anthor: MAO Zhi-hai, E-mail:zhihaimao@163.com Abstract Objective To estimate the laparoscopic ventral hernia repair(LVHR), focusing on the safety and efficiency of the operations. Methods The clinical data of 68 patients with ventral hernias (defect≤20cm) performed hernia reparing between January 2007 and August 2008 at Ruijin Hospital of Shanghai Jiao Tong University were analyzed retrospectively. Results Thirty-one patients underwent laparoscopic repair (LVHR), and 37 patients underwent open mesh repair (OVHR). The clinical outcome was determined by a median follow-up of 11 months(1~21 months) for the two groups. No significant differences were noticed between the two groups in age, sex, body mass index (BMI), and hernia size. The mean operative time was (60.5±17.7)min for LVHR patients and (75.5±30.3)min for OVHR patients (P＝0.017). The mean postoperative hospital stay was (6.2±2.5)d for LVHR patients and (9.6±8.0)d for OVHR patients (P＝0.026). 96.8% of patients (30/31) were able to return to usual activity in 2 weeks for LVHR and 78.4% of patients (29/37) for OVHR (P=0.026). LVHR patients felt less pain in the first day after operation (P＝0.018), and there were no significant differences in visual-analogue pain scores between the two groups afterward. Complications occurred in 19.4 % of LVHR patients and 24.3 % of OVHR patients (P =0.623) with a recurrence rate of 3.2% in LVHR and 5.6% in OVHR patients (P =1.000). The mean cost was (18334±5336) yuan RMB for LVHR patients and (9508±9222) yuan RMB for OVHR patients (P=0.000). Conclusion The short-term results indicate that laparoscopic technique is safe and effective for ventral hernia repairing with hernia defect less than 20cm.