开放联合腹腔镜切口疝修补术在复发性切口疝中的应用价值

Application value of combined open and laparoscopic incisional hernia repair in the treat-ment of recurrent incisional hernia

    摘要
  • 摘要:
    目的 探讨开放联合腹腔镜切口疝修补术（以下简称杂交技术）在复发性切口疝中的应用价值。
    方法 采用回顾性描述性研究方法。收集2015年1月至2021年12月首都医科大学附属北京朝阳医院收治的36例复发性切口疝患者的临床资料；男10例,女26例；年龄为62（25~83）岁。所有患者采用杂交技术进行复发性切口疝修补。观察指标：（1）术中情况。（2）术后情况。（3）随访情况。正态分布的计量资料以x±s表示,偏态分布的计量资料以M（范围）表示。计数资料以绝对数表示。
    结果 （1）术中情况。36例患者均未采用组织结构分离技术,顺利关闭疝缺损完成手术。手术时间为（102±41）min,术中测量缺损面积为（73±39）cm2；补片面积为300（150~600）cm2。36例患者中,9例术中需完整清除既往补片,2例术中需清除部分既往补片,16例术中无需清除既往补片,9例无补片植入史。36例患者中,2例发生肠管浆膜损伤,需术中修补。（2）术后情况。36例患者中,8例术后发生并发症,其中血清肿6例、皮下血肿和术中遗漏的医源性肠管损伤各1例。36例患者术后住院时间为14（7~57）d。（3）随访情况。36例患者均获得随访,随访时间为64（13~96）个月。随访期间,2例疝复发,1例发生肠梗阻。
    结论 杂交技术用于复发性切口疝修补术安全、可行。

     

    Abstract:
    Objective To investigate the application value of combined open and laparos-copic incisional hernia repair (hereinafter referred to as hybrid technique) in the treatment of recurrent incisional hernia.
    Methods The retrospective and descriptive study was conducted. The clinical data of 36 patients with recurrent incisional hernia who were admitted to the Affiliated Beijing Chaoyang Hospital of Capital Medical University from January 2015 to December 2021 were collected. There were 10 males and 26 females, aged 62(range, 25-83)years. All patients underwent incisional hernia repair using the hybrid technique. Observation indicators: (1) intraoperative situa-tions; (2) postoperative situations; (3) follow-up. Measurement data with normal distribution were represented as Mean±SD, and measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers.
    Results (1) Intraoperative situations. All 36 patients did not undergo component separation and successfully closed the hernia defect before completing the surgery. The operation time, defect area and area of mesh of the 36 patients were (102±41)minutes, (73±39)cm2 and 300(range, 150-600)cm2. Of the 36 patients, 9 cases required complete removal of the previous mesh, 2 cases had partial removal of the previous mesh and 25 cases did not require mesh removal. Two of the 36 patients had intestinal serosal tears, which needed suture repair during the operation. (2) Postoperative situations. Eight of the 36 patients had post-operative complications, including 6 cases of seroma, 1 case of subcutaneous hematoma and 1 case of undetected iatrogenic intestinal injury during the operation. The duration of the postoperative hospital stay of the 36 patients was 14(range, 7-57)days. (3) Follow-up. All 36 patients were followed up for 64 (range, 13-96)months. During the follow-up period, 2 cases had hernia recurrence and 1 case had intestinal obstruction.
    Conclusion The hybrid technique in the treatment of recurrent incisional hernia is safe and feasible.

     

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