切换至 "中华医学电子期刊资源库"
高级检索
中华疝和腹壁外科杂志(电子版)

中华疝和腹壁外科杂志(电子版) ›› 2018, Vol. 12 ›› Issue (03) : 199 -203. doi: 10.3877/cma.j.issn.1674-392X.2018.03.010

所属专题： 文献；

论著

猪小肠黏膜下层脱细胞基质补片与轻量聚丙烯补片在腹股沟疝Lichtenstein修补术中的对比研究
戴伟钢1, 左继东1, 谭进富1, 袁玉杰1, 袁凯涛1, 冯伟东1, 赵琼云1, 谭敏1,†()   
  1. 1. 510080　广州，中山大学附属第一医院胃肠外科中心，疝与腹壁外科
  • 收稿日期:2017-12-06 出版日期:2018-06-18
  • 通信作者: 谭敏
  • 基金资助:
    广东省公益研究和能力建设专项资金资助项目(2016A010103038); 国家自然科学基金-青年基金资助项目(81602660，81401307)

Safety and efficacy of porcine small intestine submucosa mesh versus lightweight polypropylene mesh for Lichtenstein inguinal hernia repair

Weigang Dai1, Jidong Zuo1, Jinfu Tan1, Yujie Yuan1, Kaitao Yuan1, Weidong Feng1, Qiongyun Zhao1, Min Tan1,†()   

  1. 1. Department of Gastrointestinal Surgery, Hernia and Abdominal Wall Surgery, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China
  • Received:2017-12-06 Published:2018-06-18
  • Corresponding author: Min Tan
  • About author:
    Corresponding author: Tan Min, Email:
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

戴伟钢, 左继东, 谭进富, 袁玉杰, 袁凯涛, 冯伟东, 赵琼云, 谭敏. 猪小肠黏膜下层脱细胞基质补片与轻量聚丙烯补片在腹股沟疝Lichtenstein修补术中的对比研究[J]. 中华疝和腹壁外科杂志(电子版), 2018, 12(03): 199-203.

Weigang Dai, Jidong Zuo, Jinfu Tan, Yujie Yuan, Kaitao Yuan, Weidong Feng, Qiongyun Zhao, Min Tan. Safety and efficacy of porcine small intestine submucosa mesh versus lightweight polypropylene mesh for Lichtenstein inguinal hernia repair[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2018, 12(03): 199-203.

目的

探讨猪小肠黏膜下层脱细胞基质（porcine small intestine submucosa，SIS）补片对比轻量聚丙烯（polypropylene mesh，PP）补片在腹股沟疝Lichtenstein修补术中应用的安全性和短期疗效。

方法

回顾性分析2012年1月至2015年8月，中山大学附属第一医院使用SIS补片和轻量PP补片做单侧腹股沟疝Lichtenstein修补术的连续男性病例资料，SIS组和PP组分别纳入64例，比较2组患者手术安全性和短期疗效。

结果

SIS组与PP组在术后24 h疼痛评分、发热、伤口脂肪液化、血清肿、尿潴留、睾丸并发症发生率比较，差异无统计学意义（P均>0.05）。2组均无手术部位感染和血肿发生病例。2组均无复发病例。SIS组在术后慢性疼痛（14.1%比15.6%，χ2=0.062，P=0.804），术后腹股沟区不适感（12.5%比17.2%，χ2=0.556，P=0.456），异物感（3.1%比4.7%，P=1.000）均低于PP组，但2组差异无统计学意义（P均>0.05）。2组在术后均无明显射精疼痛或障碍，无睾丸萎缩。PP组有2例（3.1%）患者出现手术侧睾丸肿大。

结论

SIS补片对比轻量PP补片在腹股沟疝Lichtenstein修补术中应用的安全性和短期疗效是相当的，其长期疗效仍有待进一步观察。

关键词: 疝，腹股沟, 疝修补术, 生物补片, 聚丙烯补片, 并发症, 复发
Objective

The purpose of this study was to investigate the safety and efficacy of porcine small intestine submucosa (SIS) mesh versus Lightweight polypropylene (PP) mesh in Lichtenstein repair of inguinal hernia.

Methods

From January 1 2012 to August 31 2015, the consecutive male patients of unilateral inguinal hernia undergoing Lichtenstein repair using SIS mesh and lightweight PP mesh in the First Affiliated Hospital of Sun Yat-Sen University were analyzed retrospectively. SIS group and PP group were enrolled in 64 patients respectively. The safety and short-term efficacy of the two groups were compared.

Results

There were no significant differences in pain score at 24 hours after operation, fever, wound fat liquefaction, serum swelling, urinary retention, testicular complications between the SIS group and the PP group (all P>0.05). There were no surgical site infection and hematoma cases in two groups. No recurrence occurred in two groups. Although the severity of postoperative chronic pain (14.1% vs 15.6%, χ2=0.062, P=0.804), postoperative groin discomfort (12.5% vs 17.2%, χ2=0.556, P=0.456), foreign body sensation (3.1% vs 4.7%, P=1.000) in the SIS group were lower than those in the PP group, but there was no statistically significant difference between the two groups (all P >0.05). There were no obvious ejaculatory pain or obstruction and testicular atrophy occurred in two groups. There were two cases (3.1%) of testicular swelling in PP group.

Conclusions

The safety and short-term efficacy of SIS mesh compared with light PP mesh in Lichtenstein repair of inguinal hernia are comparable, but the long-term efficacy remains to be further observed.

Key words: Hernia, inguinal, Herniorrhaphy, Biological mesh, Polypropylene mesh, Complication, Recurrence
表1 2组基线资料比较
基线项目 SIS组(64例) PP组(64例) χ2/t值 P值
年龄(岁) ? ? 2.486 0.115
? ≤65 61 56 ? ?
? >65 3 8 ? ?
职业(例) ? ? 2.696 0.260
? 非体力劳动 28 20 ? ?
? 轻体力劳动 25 27 ? ?
? 重体力劳动 11 17 ? ?
体质量指数(kg/m2,±s) 23.3±2.7 23.9±2.3 -1.414 0.1602
病程时间(个月,±s) 255.3±123.8 253.3±204.1 -0.879 0.3792
术前疼痛或坠胀感(例) 33 23 3.175 0.075
坠入阴囊(有/无,例) 11/53 9/55 0.237 0.626
疝内容物可回纳(例) 60 61 - 1.0001
基础疾病(例) ? ? ? ?
? 2型糖尿病 3 4 - 1.0001
? 高血压病 4 12 4.571 0.033
? 心脏病 1 3 - 0.6191
? 慢性阻塞性阻肺疾病 3 4 - 1.0001
? 慢性肝疾病 0 0 - NS
? 慢性肾病 3 2 - 1.0001
? 前列腺增生 5 5 0.000 1.000
术前美国麻醉医师学会分级(例) ? ? 5.076 0.079
? Ⅰ级 59 50 ? ?
? Ⅱ级 4 12 ? ?
? Ⅲ级 1 2 ? ?
疝部位(例) ? ? 0.000 1.000
? 左侧 28 28 ? ?
? 右侧 36 36 ? ?
疝分类(例) ? ? ? ?
? 斜疝 57 45 6.950 0.008
? 直疝 6 17 6.413 0.011
? 骑跨疝 1 2 ? 1.0001
? 滑动疝 0 2 ? 0.4961
? 复发疝 2 3 ? 1.0001
改良Gilbert分型(例) ? ? 8.905 0.113
? Ⅰ 2 4 ? ?
? Ⅱ 28 20 ? ?
? Ⅲ 27 21 ? ?
? Ⅳ 5 11 ? ?
? Ⅴ 1 6 ? ?
? Ⅵ 1 2 ? ?
麻醉方式(例) ? ? 0.370 0.831
? 全麻 5 7 ? ?
? 腰硬 56 54 ? ?
? 局麻 3 3 ? ?
? 切口局麻药物封闭(例) 10 11 0.057 0.811
? 平均手术时间(min,±s) 56.5±7.6 56.1±6.6 0.346 0.730
? 术后平均住院时间(d,±s) 2.4±1.0 2.2±1.0 1.166 0.246
表2 2组术后短期疗效比较[例(%)]
　 术后24 h疼痛视觉模拟量表评分 发热(>38 ℃) 伤口脂肪液化 手术部位感染 血肿 血清肿 尿潴留 睾丸并发症
0分 1~3分 4~6分
SIS组(64例) 6(9.4) 54(84.4) 4(6.2) 0 3(4.7) 0 0 2(3.1) 0 5(7.8)
PP组(64例) 7(10.9) 54(84.4) 3(4.7) 1(1.5) 2(3.2) 0 0 3(4.7) 2(3.1) 6(9.3)
χ2/t值 0.22 ? ? ? ? ? ? 0.099
P值 0.896 1.0001 1.0001 NS NS 1.0001 1.0001 0.752
表3 2组术后长期疗效比较[例（%）]
　 术后慢性疼痛(SVS) 术后腹股沟区不适感(SVS) 术后腹股沟区异物感(SVS) 术后射精疼痛或障碍 睾丸萎缩 睾丸肿大 复发
无疼痛 轻度 无不适 轻度 无 轻度
SIS组(64例) 55(85.9) 9(14.1) 56(87.5) 8(12.5) 62(96.9) 2(3.1) 0 0 0 0
PP组(64例) 54(84.4) 10(15.6) 53(82.8) 11(17.2) 61(95.3) 3(4.7) 0 0 2(3.1) 0
χ2/t值 0.062 0.556 - ? ? - 　
P值 0.804 0.456 1.0001 NS NS 0.4961 NS
[1]
Franklin ME, Gonzalez JJ, Glass JL. Use of porcine small intestinal submucosa as a prosthetic device for laparoscopic repair of hernias in contaminated fields: 2-year follow-up[J]. Hernia, 2004, 8(3): 186-189.
[2]
Ueno T, Pickett LC, De La Fuente SG, et al. Clinical application of porcine small intestinal submucosa in the management of infected or potentially contaminated abdominal defects[J]. J Gastrointest Surg, 2004, 8(1): 109-112.
[3]
Franklin ME Jr, Trevino JM, Portillo G, et al. The use of porcine small intestinal submucosa as a prosthetic material for laparoscopic hernia repair in infected and potentially contaminated fields: long-term follow-up[J]. Surg Endosc, 2008, 22(9): 1941-1946.
[4]
Ansaloni L, Catena F, Coccolini F, et al. Inguinal hernia repair with porcine small intestine submucosa: 3-year follow-up results of a randomized controlled trial of Lichtenstein's repair with polypropylene mesh versus Surgisis Inguinal Hernia Matrix[J]. Am J Surg, 2009, 198(3): 303-312.
[5]
Bochicchio GV, Jain A, Mcgonigal K, et al. Biologic vs synthetic inguinal hernia repair: 1-year results of a randomized double-blinded trial[J]. J Am Coll Surg, 2014, 218(4): 751-757.
[6]
Catena F, Ansaloni L, Leone A, et al. Lichtenstein repair of inguinal hernia with Surgisis inguinal hernia matrix soft-tissue graft in immunodepressed patients[J]. Hernia, 2005, 9(1): 29-31.
[7]
Fang Z, Ren F, Zhou J, et al. Biologic mesh versus synthetic mesh in open inguinal hernia repair: system review and meta-analysis[J]. ANZ J Surg, 2015, 85(12): 910-916.
[8]
Nie X, Xiao D, Wang W, et al. Comparison of Porcine Small Intestinal Submucosa versus Polypropylene in Open Inguinal Hernia Repair: A Systematic Review and Meta-Analysis[J]. PLoS One, 2015, 10(8): e0135073.
[9]
Antoniou SA, Kohler G, Antoniou GA, et al. Meta-analysis of randomized trials comparing nonpenetrating vs mechanical mesh fixation in laparoscopic inguinal hernia repair[J]. Am J Surg, 2016, 211(1): 239-249.
[10]
Ansaloni L, Catena F, Gagliardi S, et al. Hernia repair with porcine small-intestinal submucosa[J]. Hernia, 2007, 11(4): 321-326.
[11]
李基业. 生物补片在疝和腹壁外科的应用[J]. 中国实用外科杂志, 2012, 32(6): 435-438.
[12]
刘昶，李金松，纪艳超. 生物补片在疝外科的应用及相关研究进展[J/CD]. 中华疝和腹壁外科杂志(电子版), 2013, 7(2): 109-112.
[13]
Edelman DS. Laparoscopic herniorrhaphy with porcine small intestinal submucosa: a preliminary study[J]. JSLS, 2002, 6(3): 203-205.
[14]
Puccio F, Solazzo M, Marciano P. Comparison of three different mesh materials in tension-free inguinal hernia repair: prolene versus Vypro versus surgisis[J]. Int Surg, 2005, 90(3 Suppl): S21-S23.
[15]
Demetrashvili Z, Khutsishvili K, Pipia I, et al. Standard polypropylene mesh vs lightweight mesh for Lichtenstein repair of primary inguinal hernia: a randomized controlled trial[J]. Int J Surg, 2014, 12(12): 1380-1384.
[16]
Zhong C, Wu B, Yang Z, et al. A meta-analysis comparing lightweight meshes with heavyweight meshes in Lichtenstein inguinal hernia repair[J]. Surg Innov, 2013, 20(1): 24-31.
[17]
Bellows CF, Shadduck P, Helton WS, et al. Early report of a randomized comparative clinical trial of Strattice reconstructive tissue matrix to lightweight synthetic mesh in the repair of inguinal hernias[J]. Hernia, 2014, 18(2): 221-230.
[1] 李建美, 邓静娟, 杨倩. 两种术式联合治疗肝癌合并肝硬化门静脉高压的安全性及随访评价[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 41-44.
[2] 逄世江, 黄艳艳, 朱冠烈. 改良π形吻合在腹腔镜全胃切除消化道重建中的安全性和有效性研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 66-69.
[3] 杨体飞, 杨传虎, 陆振如. 改良无充气经腋窝入路全腔镜下甲状腺手术对喉返神经功能的影响研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 74-77.
[4] 曹迪, 张玉茹. 经腹腔镜生物补片修补直肠癌根治术后盆底疝1例[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 115-116.
[5] 陈大敏, 曹晓刚, 曹能琦. 肥胖对胃癌患者手术治疗效果的影响研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 651-653.
[6] 孟飞龙, 华帅, 张莹, 路广海. 经脐单孔腹腔镜后鞘后入路在全腹膜外腹股沟疝修补术中的应用[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 658-660.
[7] 阿冲罗布, 陈颖, 谢德坤. 腹腔镜外囊完整剥离术治疗肝包虫病效果及对患者肝功能、预后的影响[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 666-669.
[8] 邢晓伟, 刘雨辰, 赵冰, 王明刚. 基于术前腹部CT的卷积神经网络对腹壁切口疝术后复发预测价值[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 677-681.
[9] 叶晋生, 路夷平, 梁燕凯, 于淼, 冀祯, 贺志坚, 张洪海, 王洁. 腹腔镜下应用生物补片修补直肠术后盆底缺损的疗效[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 688-691.
[10] 王可, 范彬, 李多富, 刘奎. 两种疝囊残端处理方法在经腹腹膜前腹股沟疝修补术中的疗效比较[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 692-696.
[11] 袁伟, 张修稳, 潘宏波, 章军, 王虎, 黄敏. 平片式与填充式腹股沟疝修补术的疗效比较[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 697-701.
[12] 夏松, 姚嗣会, 汪勇刚. 经腹腹膜前与疝环充填式疝修补术治疗腹股沟疝的对照研究[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 702-705.
[13] 姜明, 罗锐, 龙成超. 闭孔疝的诊断与治疗：10年73例患者诊疗经验总结[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 706-710.
[14] 王小娜, 谭微, 李悦, 姜文艳. 预测性护理对结直肠癌根治术患者围手术期生活质量、情绪及并发症的影响[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 525-529.
[15] 符梅沙, 周玉华, 李慧, 薛春颜. 淋巴细胞免疫治疗对复发性流产患者外周血T淋巴细胞亚群分布与PD1/PD-L1表达的影响及意义[J]. 中华临床医师杂志(电子版), 2023, 17(06): 726-730.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号