[1]朱江 黄海军 庄云峰 梅虎 朱时雨 杨孟选**①.腹腔镜完全腹膜外补片修补与腹腔镜腹腔内补片修补治疗两侧下腹壁切口疝的临床疗效比较[J].中国微创外科杂志,2022,01(3):208-212.
　Zhu Jiang,Huang Haijun,Zhuang Yunfeng,et al.Comparison of Clinical Efficacy Between Laparoscopic Totally Extraperitoneal Sublay and Laparoscopic Intraperitoneal Onlay Mesh for Treating Incisional Hernia on Both Sides of Lower Abdomen[J].Chinese Journal of Minimally Invasive Surgery,2022,01(3):208-212.
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腹腔镜完全腹膜外补片修补与腹腔镜腹腔内补片修补治疗两侧下腹壁切口疝的临床疗效比较()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2022年3期
页码:
208-212
栏目:
临床研究
出版日期:
2022-06-02

文章信息/Info

Title:
Comparison of Clinical Efficacy Between Laparoscopic Totally Extraperitoneal Sublay and Laparoscopic Intraperitoneal Onlay Mesh for Treating Incisional Hernia on Both Sides of Lower Abdomen
作者:
朱江 黄海军 庄云峰 梅虎 朱时雨 杨孟选**①
(新疆维吾尔自治区第三人民医院腹部外科，乌鲁木齐830000)
Author(s):
Zhu Jiang;  Huang Haijun;  Zhuang Yunfeng;  et al.
Department of Abdominal Surgery, Third People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830000, China
关键词:
切口疝; 腹腔镜; 疝修补; 疝补片; 腹膜外
Keywords:
Incisional hernia; Laparoscopy; Herniorrhaphy; Hernia patch; Extraperitoneal
文献标志码:
A
摘要:
目的比较腹腔镜完全腹膜外补片修补术(totally extraperitoneal sublay，TES)与腹腔镜腹腔内补片修补术(intraperitoneal onlay mesh，IPOM)治疗两侧下腹壁切口疝的临床疗效。方法选取2017年5月~2020年5月我院两侧下腹壁切口疝41例,随机分为2组：IPOM组21例，接受IPOM；TES组20例，接受TES。对比分析2组围术期指标(手术时间、术中出血量、引流管放置时间、首次进食时间、术后1周疼痛评分、住院时间、住院费用)、术后短期并发症(切口裂开、术区积液、术区血清肿、急性肠梗阻)和长期并发症(慢性疼痛、慢性不全性肠梗阻、肠漏、疝复发)。结果TES组手术时间［(131.3±16.6)min vs.(78.3±78)min，t=-12.950，P=0.000］和术中出血量［(12.8±4.4)ml vs.(10.5±1.5)ml，t=-2.177，P=0040］显著长于/多于IPOM组，术后1周疼痛评分［(3.1±0.7)分vs.(4.3±0.6)分，t=5.573，P=0.000］、住院费用［(1.36±0.07)万元vs.(3.57±0.35)万元，t=27.392，P=0.000］和术后长期并发症发生率［10.0%(2/20) vs.42.9%(9/21)， χ2=5.634，P=0.018］显著低于IPOM组。2组引流管放置时间、首次进食时间、住院时间和术后短期并发症发生率差异均无统计学意义(P>0.05)。结论与IPOM比较，TES治疗两侧下腹壁切口疝使用不同于IPOM的补片和修补方式，在术后1周疼痛评分、住院费用和长期并发症方面具有优势，但TES手术时间长，操作难度大。
Abstract:
ObjectiveTo compare clinical efficacy between laparoscopic totally extraperitoneal sublay (TES) and laparoscopic intraperitoneal onlay mesh (IPOM) for treating incisional hernia on both sides of lower abdomen.MethodsA prospective randomized controlled trial was performed on 41 patients who were diagnosed as having incisional hernia on both sides of lower abdomen in our hospital from May 2017 to May 2020. Two groups were randomly divided: 21 patients underwent laparoscopic IPOM (IPOM group) and other 20 patients underwent laparoscopic TES (TES group). The perioperative data (operation time, blood loss, drainage tube removal time, time to first diet, postoperative pain score after 1 week, hospital stay, and hospital costs), incidence of shortterm postoperative complications (incision’s postoperative cracking, effusion in surgical area, seroma in surgical area, and acute intestinal obstruction) and longterm postoperative complications (chronic pain, chronic incomplete intestinal obstruction, intestinal leakage, and hernia recurrence) were compared and analyzed.ResultsThe TES group had significantly longer operation time ［(131.3±16.6) min vs. (78.3±7.8) min, t=-12.950, P=0.000］ and more blood loss ［(12.8±4.4) ml vs. (10.5±1.5) ml, t=-2.177, P=0.040］ than the IPOM group, but it had significantly less postoperative pain score after 1 week ［(3.1±0.7) points vs. (4.3±0.6) points, t=5.573, P=0.000］, lower hospital costs ［(1.36±0.07) ten thousand yuan vs. (3.57±035) ten thousand yuan, t=27.392, P=0000］ and lower incidence of longterm postoperative complications ［10.0% (2/20) vs. 429% (9/21), χ2=5.634, P=0.018］. There were not significantly differences in drainage tube removal time, time to first diet, hospital stay and the incidence of shortterm postoperative complications between the two groups (P>005).ConclusionLaparoscopic TES for treating incisional hernia on both sides of lower abdomen, using different hernia patch and herniorrhaphy method, is superior to laparoscopic IPOM in postoperative pain score after 1 week, hospital costs and incidence of longterm postoperative complications, but has longer operation time and more difficult operation technology.

参考文献/References:

[1]Sauerland S, Walgenbach M,Habermalz B, et al. Laparoscopic versus open surgical techniques for ventral or incisional hernia repair. Cochrane Database Cyst Rev,2011,16(3):781-787.
[2]Marx L, Raharimanantsoa M, Mandala S, et al. Laparoscopic treatment of incisional and primary ventral hernia in morbidly obese patients with a BMI over 35. Surg Endosc,2014,28(12):3310-3314.
[3]康德新,刘威,张磊,等.腹腔镜切口疝修补术与开放式切口疝修补术治疗腹壁切口疝的术式选择与疗效对比分析.中华疝和腹壁外科杂志(电子版),2016,10(6):455-457.
[4]Albino FP, Patel KM, Nahabedian MY, et al. Does mesh location matter in abdominal wall reconstruction? A systematic review of the literature and a summary of recommendations. Plast Reconstr Surg,2013,132(5):1295-1304.
[5]乐飞,李健文.腹腔镜腹壁切口疝修补术存在的问题、争议与对策.中华实用外科杂志,2018,38(2):183-186.
[6]Zhu LM, Schuster P, Klinge U, et al. Mesh implants: An overview of crucial mesh parameters. World J Gastrointest Surg,2015,7(10):226-236.
[7]李炳根.内镜下全内囊分离技术:腹壁疝微创新理念.中华消化外科杂志,2019,18(11):1022-1026.
[8]李炳根,李颖,龚独辉,等.增强视野完全腹膜外疝修补术在下腹疝患者中的应用.中华疝和腹壁外科杂志(电子版),2018,12(5):363-366.
[9]Li B, Qin C, Bittner R, et al. Totally endoscopic sublay (TES) repair for midline ventral hernia: surgical technique and preliminary results. Surg Endosc,2020,34(4):1543-1550.
[10]Chowbey PK, Sharma A, Khullar R, et al. Laparoscopic ventral hernia repair with extraperitoneal mesh: surgical technique and early results. Surg Laparosc Endosc Tech,2003,13(2):101-105.
[11]GPC Y. From intraperitoneal onlay mesh repair to preperitoneal onlay mesh repair. Asian J Endosc Surg,2017,10(2):119-127.
[12]Belyansky I, Daes J, Radu VG, et al. A novel approach using the enhancedview totally extraperitoneal (eTEP) technique for laparoscopic retromuscular hernia repair. Surg Endosc,2018,32(3):1523-1532.
[13]颜虹，主编.医学统计学(八年制).第2版.北京:人民卫生出版社,2010.264-269.
[14]蒋会勇,马锐,郭一君,等.逆向穿刺法建立腹膜前间隙在腹腔镜完全腹膜外疝修补术中的应用.腹腔镜外科杂志,2015,20(6):455-457.
[15]王明镜,黄鹤光,林贤超,等.腹腔镜经腹膜前腹股沟疝修补术残端疝囊处理方式对术后血清肿影响的前瞻性研究.中华消化外科杂志,2020,19(1):81-86.
[16]王平.腹腔镜腹部疝修补术后血清肿分型的解读.中华疝和腹壁外科杂志(电子版),2013,7(2):107-108.
[17]李民,刘小卫,熊俊,等.腹股沟疝无张力修补术712例术后并发症原因分析.中华疝和腹壁外科杂志(电子版),2010,4(3):270-274.
[18]Loss MJA, Roumen RMH, Scheltinga MRM. Classifying postherniorrhaphy pain syndromes follow elective inguinal hernia repair. World J Surg,2007,31:1760-1765.
[19]Appleby PW, Martin TA, Hope WW. Umbilical hernia repair: Overview of approaches and review of literature. Surg Clin North Am,2018,98(3):561-576.
[20]赵明一,高峰,陈涛,等.腹腔镜与开放无张力疝修补术治疗成人脐疝临床效果分析.国际外科学杂志,2019,46(4):246-250.
[21]王明镜,黄鹤光,林贤超,等.腹腔镜经腹膜前腹股沟疝修补术残端疝囊处理方式对术后血清肿影响的前瞻性研究.中华消化外科杂志,2020,19(1):81-86.
[22]储修峰,吴志明,孟兴成,等.经腹部分腹膜外修补术治疗下腹壁切口疝.中国微创外科杂志,2018,18(10):946-949.
[23]Zeichen MS, Lujan HJ, Mata WN, et al. Closure versus nonclosure of hernia defect during laparoscopic ventral hernia repair with mesh. Hernia,2013,17(5):589-596.
[24]Nguyen DH, Nguyen MT, Askenasy EP, et al. Primary fascial closure with laparoscopic ventral hernia repair:systematic review. World J Surg,2014,38(12):3097-3104.

备注/Memo

备注/Memo:
基金项目:新疆维吾尔自治区卫生健康青年医学科技人才专项科研项目(WJWY-201941)**通讯作者，Email：yangmengxuan@fudan.edu.cn ①（复旦大学附属闵行医院上海市闵行区中心医院胃肠外科，上海201100）
更新日期/Last Update: 2022-06-02