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) ›› 2021, Vol. 15 ›› Issue (03) : 288 -292. doi: 10.3877/cma.j.issn.1674-392X.2021.03.019

临床论著

脱细胞基质材料在腹腔镜治疗青年腹股沟疝临床效果
陈俊生1, 宋晓彪1,†(), 郭剑辉2, 朱熠林3, 刘雨辰3   
  1. 1. 014040　包头市中心医院普外三科
    2. 010020　呼和浩特市第一医院普外三科
    3. 100043　首都医科大学附属北京朝阳医院疝和腹壁外科
  • 收稿日期:2020-02-06 出版日期:2021-06-18
  • 通信作者: 宋晓彪

Retrospective comparative analysis of acellular matrix materials in laparoscopic treatment of young adults with inguinal hernia

Junsheng Chen1, Xiaobiao Song1,†(), Jianhui Guo2, Yilin Zhu3, Yuchen Liu3   

  1. 1. 3Department of General Surgery, Baotou City Central Hospital, Baotou 014040, China
    2. 3Department of General Surgery, Hohhot First Hospital, Hohhot 010020, China
    3. Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100043, China
  • Received:2020-02-06 Published:2021-06-18
  • Corresponding author: Xiaobiao Song
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

陈俊生, 宋晓彪, 郭剑辉, 朱熠林, 刘雨辰. 脱细胞基质材料在腹腔镜治疗青年腹股沟疝临床效果[J]. 中华疝和腹壁外科杂志(电子版), 2021, 15(03): 288-292.

Junsheng Chen, Xiaobiao Song, Jianhui Guo, Yilin Zhu, Yuchen Liu. Retrospective comparative analysis of acellular matrix materials in laparoscopic treatment of young adults with inguinal hernia[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2021, 15(03): 288-292.

目的

对比生物材料和人工合成材料在腹腔镜治疗青年腹股沟疝的临床效果。

方法

基于中国疝病登记随访系统，回顾性分析2017年10月至2018年12月数据库内首都医科大学附属北京朝阳医院疝和腹壁外科采用猪小肠黏膜下层脱细胞基质（SIS）补片行腹腔镜腹股沟疝修补手术患者的临床和随访资料，比较2组患者的相关临床指标。

结果

共计248例患者的资料纳入本研究，其中生物组86例，合成组162例。2组患者的一般资料、术后住院时间、复发率、慢性疼痛发生率比较，差异无统计学意义（P>0.05）；生物组的术后发热数多于合成组，差异有统计学意义（P<0.05）；随访期内生物组的血清肿发生率明显高于合成组，差异有统计学意义（P<0.05）；术后1周和术后1月2组患者的视觉模拟评分比较，差异有统计学意义（P<0.05）；生物组异物感发生率低于合成组，差异有统计学意义（P=0.021）。

结论

SIS补片在腹腔镜治疗青年腹股沟疝患者中能够取得较好的治疗效果，具有较低的异物感和术后疼痛，但可能引起更高的血清肿发生率，需要个体化选择。

关键词: 疝，腹股沟, 青年, 生物材料, 腹腔镜
Objective

To compare effect of biomaterials and synthetic materials in laparoscopic treatment of young cases with inguinal hernia.

Methods

The clinical and follow-up data of laparoscopic inguinal hernia repair with porcine small intestinal submucosa (SIS) mesh in Beijing Chaoyang Hospital from October 2017 to December 2018 were analyzed retrospectively based on the Chinese Hernia College Registry and Follow-up System. Relevant indicators of two groups were compared.

Results

A total of 248 cases were included in this study, including 86 in biological group and 162 in synthetic group. There were no significant differences between two groups in general information, postoperative hospital stay, recurrence rate and incidence of chronic pain (P>0.05). The number of postoperative fever in biological group was higher than that in synthetic group (P<0.05). The incidence of seroma in biological group was significantly higher than that in synthetic group during follow-up period (P<0.05). There was significant difference in VAS scores between two groups at 1 week and 1 month after operation (P<0.05). The incidence of foreign body sensation was lower in biological group (P=0.021).

Conclusion

SIS mesh could achieve better therapeutic effect in laparoscopic treatment of young cases with inguinal hernia, with lower foreign body sensation and postoperative pain, but it may cause higher incidence of seroma. Individual choice is necessary.

Key words: Hernia, inguinal, Youth, Biomaterial, Laparoscopes
图1 入选病例资料及结果
表1 2组患者一般资料比较
变量 生物组(86例) 聚丙烯组(162例) P值
性别[例(%)]     0.035
  男性 54(62.8) 141(87.0)
  女性 32(37.2) 21(13.0)
年龄 26.3±7.1 25.4±8.0 0.853
BMI(kg/m2, ±s) 18.1±3.5 19.0±2.8 0.137
合并情况[例(%)]      
  吸烟 19(22.1) 45(27.8) 0.248
  高血压 1(1.2) 1(0.6) 0.514
  下腹部手术史 7(8.1) 21(13.0) 0.181
  胃炎 3(3.5) 7(4.3) 0.794
疝位置[例(%)]     0.601
  左侧 28(32.6) 41(25.3)  
  右侧 46(53.4) 87(53.7)
  双侧 12(14.0) 34(21.0)
疝分型[例(%)]     0.876
  Ⅰ型 20(23.3) 40(24.7)  
  Ⅱ型 65(75.5) 119(73.5)
  Ⅲ型 1(1.2) 3(1.8)
ASA分级[例(%)]     0.459
  Ⅰ级 85(98.8) 160(98.8)  
  Ⅱ级 1(1.2) 2(1.2)
术前VAS评分(分, ±s) 1.6±0.4 1.9±0.5 0.213
术后住院时间(d, ±s) 1.6±0.5 1.3±0.2 0.345
表2 2组患者观察项目
变量 生物组(86例) 聚丙烯组(162例) P值
发热[例(%)] 9(10.5) 2(1.2) 0.014
  复发 0 0 -
  感染 0 0 -
血清肿[例(%)]      
  1周 81(94.2) 23(14.2) <0.001
  1个月 67(77.9) 14(8.6) <0.001
  3个月 45(52.3) 9(5.5) <0.001
  1年 13(15.1) 2(1.2) 0.001
慢性疼痛[例(%)] 1(1.2) 3(1.9) 0.312
术后VAS评分(分, ±s)      
  1周 1.7±0.2 2.7±1.6 0.009
  1个月 0.4±0.1 1.8±0.9 0.011
  3个月 0.6±0.1 0.9±0.2 0.321
  1年 0.2±0.1 0.2±0.1 0.985
异物感[例(%)] 2(2.3) 12(7.4) 0.021
  轻度 1 9  
  中度 1 3  
  重度 0 0  
[1]
Fitzgibbons RJ Jr, Forse RA. Clinical practice. groin hernias in adults[J]. N Engl J Med, 2015, 372(8): 756-763.
[2]
Pahwa HS, Kumar A, Agarwal P, et al. Current trends in laparoscopic groin hernia repair: A review[J]. World J Clin Cases, 2015, 3(9): 789-792.
[3]
Celebi S, Aksoy D, Cevik B, et al. An electrophysiologic evaluation of whether open and laparoscopic techniques used in pediatric inguinal hernia repairs affect the genitofemoral nerve[J]. J Pediatr Surg, 2013, 48(10): 2160-2163.
[4]
Simons MP, Aufenacker T, Bay-Nielsen M, et al. European hernia society guidelines on the treatment of inguinal hernia in adult patients[J].Hernia, 2009, 13(4): 343-403.
[5]
Bittner R, Montgomery MA, Arregui E, et al. International Endohernia Society update of guidelines on laparoscopic(TAPP) and endoscopic(TEP) treatment of inguinal hernia(International Endohernia Society)[J]. Surg Endosc, 2015, 29(2): 289-321.
[6]
Zhu Y, Liu M, Li J, et al. Closure of direct inguinal hernia defect in laparoscopic hernioplasty to prevent seroma formation: a prospective double-blind randomized controlled trial[J]. Surg Laparosc Endosc Percutan Tech, 2019, 29(1): 18-21.
[7]
Yang S, Zhang G, Jin C, et al. Transabdominal preperitoneal laparoscopic approach for incarcerated inguinal hernia repair: a report of 73 cases[J]. Medicine, 2016, 95(52): e5686.
[8]
Liu J, Zhu YL, Shen YM, et al. The feasibility of laparoscopic management of incarcerated obturator hernia[J]. Surg Endosc, 2017, 31(2): 656-660.
[9]
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.
[10]
Zieren J, Zieren HU, Jacobi CA, et al. Prospective randomized study comparing laparoscopic and open tension-free inguinal hernia repair with shouldice’s operation[J]. Am J Surg, 1998, 175(4): 330-333.
[11]
HerniaSurge Group. International guidelines for groin hernia management[J]. Hernia, 2018, 22(1): 1-165.
[12]
秦昌富，李炳根，申英末, 等. 中国疝病注册登记随访系统的建立和发展[J]. 外科理论与实践, 2018, 23(4): 8-11.
[13]
秦昌富，申英末，李炳根, 等. 中国疝病注册登记随访系统发展现状及数据初步分析[J]. 中华消化外科杂志, 2018, 17(11): 1087-1089.
[14]
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.
[15]
Köckerling F, Alam NN, Antoniou SA, et al. What is the evidence for the use of biologic or biosynthetic meshes in abdominal wall reconstruction?[J]. Hernia, 2018, 22(2): 249-269.
[16]
Öberg S, Andresen K, Rosenberg J. Absorbable meshes in inguinal hernia surgery: a systematic review and meta-analysis[J]. Surg Innov, 2017, 24(3): 289-298.
[17]
李绍杰，唐健雄，李绍春, 等. 应用生物材料行腹股沟后壁加强重建技术治疗青年腹股沟疝疗效分析[J]. 中国实用外科杂志, 2019, 39(8): 821-824.
[18]
曹桢，刘雨辰，申英末, 等.SSI补片在不同术式治疗青壮年腹股沟疝中的应用效果.中国普通外科杂志.2019, 28(10): 1-6.
[19]
王宝山，申英末，陈富强, 等. SSI材料生物补片在腹腔镜经腹腹膜前疝修补术中的应用[J/OL].中华疝和腹壁外科杂志(电子版), 2016, 10(2): 85-88.
[20]
Agresta F, Bedin N. Transabdominal laparoscopic inguinal hernia repair: is there a place for biological mesh?[J]. Hernia, 2008, 12(6): 609-612.
[21]
Ansaloni L, Cambrini P, Catena F, et al. Immune response to small intestinal submucosa(surgisis) implant in humans: preliminary observations[J]. J Invest Surg, 2007, 20(4): 237-241.
[1] 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.
[2] 李凯, 陈淋, 向涵, 苏怀东, 张伟. 一种U型记忆合金线在经脐单孔腹腔镜阑尾切除术中的临床应用[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 15-15.
[3] 杜晓辉, 崔建新. 腹腔镜右半结肠癌D3根治术淋巴结清扫范围与策略[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 5-8.
[4] 周岩冰, 刘晓东. 腹腔镜右半结肠癌D3根治术消化道吻合重建方式的选择[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 9-13.
[5] 张焱辉, 张蛟, 朱志贤. 留置肛管在中低位直肠癌新辅助放化疗后腹腔镜TME术中的临床研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 25-28.
[6] 王春荣, 陈姜, 喻晨. 循Glisson蒂鞘外解剖、Laennec膜入路腹腔镜解剖性左半肝切除术临床应用[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 37-40.
[7] 李晓玉, 江庆, 汤海琴, 罗静枝. 围手术期综合管理对胆总管结石并急性胆管炎患者ERCP +LC术后心肌损伤的影响研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 57-60.
[8] 甄子铂, 刘金虎. 基于列线图模型探究静脉全身麻醉腹腔镜胆囊切除术患者术后肠道功能紊乱的影响因素[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 61-65.
[9] 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.
[10] 李三祥, 李佳, 刘俊峰, 吕东晨, 方晖东, 谭朝晖, 刘杰, 潘佐, 乔建坤. 基于CT影像的三维重建成像技术在腹腔镜大肾上腺肿瘤切除术中的应用[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(06): 570-574.
[11] 赵佳晖, 王永兴, 彭涛, 李明川, 魏德超, 韩毅力, 侯铸, 姜永光, 罗勇. 后腹腔镜根治性肾切除手术时间延长和术中出血量增多的影响因素分析[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(06): 575-580.
[12] 汪帮琦, 陈波特, 林浩坚, 许晖阳, 王镇伟, 袁雪峰, 林康健, 邱晓拂. 经腹入路3D腹腔镜联合输尿管硬镜同期处理肾盂输尿管连接部梗阻并肾盏结石的应用[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(06): 597-600.
[13] 林文斌, 郑泽源, 郑文能, 郁毅刚. 外伤性脾破裂腹腔镜脾切除术患者中转开腹风险预测模型构建[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 619-623.
[14] 牛朝, 李波, 张万福, 靳文帝, 王春晓, 李晓刚. 腹腔镜袖状胃切除联合胆囊切除治疗肥胖合并胆囊结石安全性和疗效[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 635-639.
[15] 李博, 胡刚, 邱文龙, 汤坚强, 王锡山. 多功能吲哚菁绿近红外荧光血管成像技术在腹腔镜直肠癌经自然腔道取标本手术（NOSES Ⅳ式）中的应用（附视频）[J]. 中华结直肠疾病电子杂志, 2023, 12(06): 524-528.
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