DynaMesh-IPST造口专用补片在腹壁造瘘口旁疝修补术中的应用价值

Application value of DynaMesh-IPST stoma dedicated mesh in parastomal hernia repair

    摘要
  • 摘要: 目的:探讨DynaMesh-IPST造口专用补片在腹壁造瘘口旁疝修补术中的应用价值。
    方法:采用回顾性队列研究方法。收集2013年3月至2017年4月首都医科大学附属北京朝阳医院收治的281例腹壁造瘘口旁疝患者的临床资料。281例患者均行腹腔镜联合开放人工材料腹壁造瘘口旁疝修补术，其中151例使用DynaMesh IPST造口专用补片，设为DynaMesh-IPST补片组；130例使用普通防粘连补片，设为普通补片组。观察指标：(1)术中及术后情况。(2)随访情况。患者术后1个月、3个月、6个月、1年采用门诊和电话方式进行随访，了解疝复发和长期并发症情况。随访时间截至2018年6月。正态分布的计量资料以±s表示，组间比较采用t检验；偏态分布的计量资料以M(P25，P75)和M(范围)表示，组间比较采用秩和检验。计数资料组间比较采用x2检验。
    结果:(1)术中及术后情况：281例患者均顺利完成腹腔镜联合开放人工材料腹壁造瘘口旁疝修补术。DynaMesh-IPST补片组和普通补片组患者手术时间分别为 100 min(60 min，120 min)和100 min(85 min，120 min)，术中出血量分别为(34±15)mL和(42±36)mL，术后住院时间分别为17 d(13 d，24 d)和20 d(16 d，25 d)，两组患者上述指标比较，差异均有统计学意义(Z=2.166，t=2.654，Z=2.795，P<0.05)。DynaMesh-IPST补片组术后18例患者发生切口感染，其中2例合并肠漏；普通补片组术后36例患者发生切口感染，其中7例合并肠漏，两组患者术后切口感染比较，差异有统计学意义(x2=11.194，P<0.05)；术后肠漏比较，差异无统计学意义(x2=4.234，P>0.05)。54例发生术后切口感染的患者中，4例经手术清除补片及感染灶后痊愈，50例经换药、局部清创引流后痊愈。(2)随访情况：281例患者中，279例获得随访，其中DynaMesh-IPST补片组149例，普通补片组130例。随访时间为32个月(20～44个月)。随访期间，10例患者疝复发(DynaMesh-IPST补片组4例、普通补片组6例)，其中行再次手术修补6例(4例为“钥匙孔疝”复发、1例为造瘘口处腹壁薄弱补片向外膨出、1例为肠漏清除补片后造瘘口旁疝复发)，其余4例予以腹带固定，定期复查。两组患者疝复发比较，差异无统计学意义(x2=0.318，P>0.05)。27例患者发生肠梗阻，其中DynaMesh-IPST补片组14例、普通补片组13例，经保守治疗后均好转，两组比较，差异无统计学意义(x2=0.043，P>0.05)。10例患者发生造瘘口狭窄，其中DynaMesh-IPST补片组6例，普通补片组4例，均经局部造瘘口重塑后好转，两组比较，差异无统计学意义(x2=0.007， P>0.05)。19例患者发生造瘘口脱垂，其中DynaMesh-IPST补片组4例(伴疝复发 1例)，普通补片组15例(伴疝复发2例)，经局部造瘘口重塑后好转，两组比较，差异有统计学意义(x2=8.756，P<0.05)。
    结论:    采用DynaMesh-IPST造口专用补片行腹壁造瘘口旁疝修补术安全有效，疗效满意。

     

    Abstract: Objective:To investigate the application value of DynaMesh-IPST stoma dedicated mesh in parastomal hernia repair.
    Methods:The retrospective cohort study was conducted. The clinical data of 281 patients with parastomal hernia of abdominal wall who were admitted to Beijing ChaoYang Hospital of Capital Medical University between March 2013 and April 2017 were collected. Of 281 patients undergoing laparoscopic combined with open parastomal hernia repair with artificial materials, 151 using DynaMesh-IPST stoma dedicated mesh and 130 using ordinary antiadhesive mesh were respectively allocated into the DynaMesh-IPST mesh group and ordinary mesh group. Observation indicators: (1) intra and postoperative situations; (2) follow-up. follow-up using outpatient examination and telephone interview was performed to detect hernia recurrence and longterm complications at 1, 3, 6month and 1 year postoperatively up to June 2018. Measurement data with normal distribution were represented as ±s and comparison between groups was done by the t test. Measurement data with skewed distribution were described as M (P25,P75) and M (range), and comparison between groups was done using rank sum test. Comparison of count data between groups was analyzed using the chisquare test.
    Results:     (1) Intra and postoperative situations: 281 patients underwent successfully laparoscopic combined with open parastomal hernia repair with artificial materials. The operation time, volume of intraoperative blood loss and duration of postoperative hospital stay were 100 minutes (60 minutes, 120 minutes), (34±15)mL, 17 days (13 days, 24 days) in the DynaMesh-IPST mesh group and 100 minutes (85 minutes,120 minutes), (42± 36)mL and 20 days (16 days, 25 days) in the ordinary mesh group, with statistically significant differences between groups (Z=2.166, t=2.654, Z=2.795, P<0.05). The postoperative incisional infection and intestinal leakage were respectively detected in 18 and 2 patients in the DynaMesh-IPST mesh group and 36 and 7 patients in the ordinary mesh group, showing a statistically significant difference of incisional infection between groups (x2=11.194, P<0.05), and no statistically significant difference of intestinal leakage between groups (x2=4.234, P>0.05). Of 54 patients with postoperative incisional infection, 4 were cured after removing mesh and clearing up infection, 50 were cured after dressing change, local debridement and drainage. (2) follow-up: 279 of 281 patients including 149 in the DynaMesh-IPST mesh group and 130 in the ordinary mesh group were followed up for 20-44 months with a median time of 32 months. During the follow-up, 10 patients had hernia recurrence including 4 in the DynaMesh-IPST mesh group and 6 in the ordinary mesh group. Six of them underwent reoperation (4 with keyhole hernia recurrence, 1 with mesh bulging out because of abdominal weakness at stoma, 1 with parastomal recurrence after mesh removal due to intestinal leakage) and 4 had regular reexamination after fixation with abdominal belt. There was no statistically significant difference of hernia recurrence between groups (x2=0.318, P>0.05). Twentyseven patients (14 in the DynaMesh-IPST mesh group and 13 in the ordinary mesh group) with intestinal obstruction were improved by conservative treatment, showing no statistically significant difference between groups (x2=0.043, P>0.05). Ten patients (6 in the DynaMesh-IPST mesh group and 4 in the ordinary mesh group) with stoma stenosis were improved after local stoma remodeling, showing no statistically significant difference between groups (x2=0.007, P>0.05). Ninteen patients (4 in the DynaMesh-IPST mesh group including 1 complicated with hernia recurrence and 15 in the ordinary mesh group including 2 complicated with hernia recurrence) with stoma prolapse were improved after local stoma remodeling, showing a statistically significant difference between groups (x2=8.756, P<0.05).
    Conclusion:Parastomal hernia repair with DynaMesh-IPST stoma dedicated mesh is safe and feasible, with satisfactory effects.

     

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