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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 (06) : 613 -616. doi: 10.3877/cma.j.issn.1674-392X.2021.06.017

临床论著

腹膜前间隙与腹腔内补片置入层次对治疗切口疝的疗效比较
张国林1, 帕尔哈提·阿布都热依木1,†()   
  1. 1. 830000　乌鲁木齐，新疆医科大学第六附属医院普外科
  • 收稿日期:2020-12-20 出版日期:2021-12-20
  • 通信作者: 帕尔哈提·阿布都热依木
  • 基金资助:
    新疆维吾尔自治区自然科学基金(2016D01C217)

A comparative study of intraperitoneal repair and preperitoneal repair in the treatment of incisional hernia

Guolin Zhang1, Abudureyimu Paerhati·1,†()   

  1. 1. Department of General Surgery, the Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi 830000, China
  • Received:2020-12-20 Published:2021-12-20
  • Corresponding author: Abudureyimu Paerhati·
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引用本文：

张国林, 帕尔哈提·阿布都热依木. 腹膜前间隙与腹腔内补片置入层次对治疗切口疝的疗效比较[J]. 中华疝和腹壁外科杂志(电子版), 2021, 15(06): 613-616.

Guolin Zhang, Abudureyimu Paerhati·. A comparative study of intraperitoneal repair and preperitoneal repair in the treatment of incisional hernia[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2021, 15(06): 613-616.

目的

比较腹膜前间隙与腹腔内补片置入层次对治疗切口疝的疗效及并发症情况。

方法

回顾性分析2017年10月至2019年10月于新疆医科大学第六附属医院普外科进行治疗的切口疝65例患者的临床资料。根据治疗方式分为腹腔内补片植入修补法（IPOM）组（31例）和Sublay组（34例）。IPOM组采用IPOM；Sublay组采用腹膜前修补术。观察2组手术相关指标、并发症、术后疼痛和复发情况。

结果

IPOM组患者的术中出血量、术后住院时间、术后72 h视觉模拟评估法（VAS）评分分别为（29.0±6.5）ml、（6.1±1.8）d、（1.94±0.77）分；Sublay组分别为（35.3±7.4）ml、（8.9±2.1）d、（2.91±0.83）分均低于IPOM组。IPOM组住院总费用（29 119.6±2490.7）高于Sublay组（24 062.0±3315.9）元，差异均有统计学意义（P<0.05）。IPOM组并发症总发生情况3例（9.68%）低于Sublay组6例（17.65%）；随访期间IPOM组未见复发，Sublay组有2例（5.88%）复发，差异均无统计学意义（均P>0.05）。

结论

IPOM与腹腔内修补均安全有效，建议根据患者的个体化情况，选择合适而有效的治疗方法。

关键词: 切口疝, 疝修补术, 并发症
Objective

To investigate the effect and complications of preperitoneal space and intraperitoneal mesh placement in the treatment of incisional hernia.

Methods

The clinical data of 65 patients with incisional hernia treated by the Department of General surgery of the sixth affiliated Hospital of Xinjiang Medical University from October 2017 to October 2019 were retrospectively analyzed. The patients were divided into intraperitoneal onlay mesh (IPOM) technique group and Sublay group according to the treatment method. Among them, 31 cases in IPOM group were treated with intraperitoneal repair, and 34 cases in Sublay group were treated with preperitoneal repair. The operation-related indexes, complications, postoperative pain and recurrence of the two groups were observed.

Results

The intraoperative bleeding (29.0±6.5) ml, postoperative hospital stay (6.1±1.8) days and 72 hours visual analogue score (VAS) (1.94±0.77) points of IPOM group were lower than those of sublay group (35.3±7.4) ml, (8.9±2.1) days, (2.91±0.83) points. The total cost of hospitalization in IPOM group (29 119.6±2490.7) yuan was higher than that in Sublay group (24 062.0±3315.9) yuan. The differences were statistically significant (P<0.05). The total incidence of complications in IPOM group (3 cases, 9.68%) was lower than that in Sublay group (6 cases, 17.65%). During the follow-up, there were 0 cases of recurrence in the IPOM group and 2 cases (5.88%) in the Sublay group. There was no significant difference (P>0.05).

Conclusion

Both preperitoneal repair and intraperitoneal repair are safe and effective. Appropriate and effective treatment methods should be selected according to the individual situation of patients.

Key words: Incisional hernia, Herniorrhaphy, Complication
表1 2组患者一般资料对比（±s）
组别 例数 男性/女性(例) 年龄(岁) 体质量指数(kg/m2) 腹壁缺损大小(cm)
IPOM组 31 14/17 60.5±7.39 24.0±1.90 9.7±1.8
Sublay组 34 15/19 62.3±7.80 23.7±1.88 9.9±2.0
χ2/t值   0.007 0.926 0.764 0.560
P值   0.933 0.358 0.448 0.577
表2 2组患者手术相关指标对比（±s）
组别 例数 手术时间(min) 术后住院时间(d) 术中出血(ml) 住院总费用(元)
IPOM组 31 106.6±21.3 6.1±1.8 29.0±6.5 29 119.6±2490.7
Sublay组 34 111.0±19.9 8.9±2.1 35.3±7.4 24 062.0±3315.9
t值   0.863 5.268 3.613 6.899
P值   >0.05 <0.05 <0.05 <0.05
表3 2组患者并发症对比[例（%）]
组别 例数 肠管损伤 肠梗阻 血清肿 切口感染 并发症总数
IPOM组 31 1(3.23) 2(6.45) 0 0 3(9.68)
Sublay组 34 0 1(2.94) 2(5.88) 3(8.82) 6(17.65)a
表4 2组患者VAS评分对比（分，±s）
组别 例数 术后24 h 术后72 h
IPOM组 31 4.90±1.04 1.94±0.77
Sublay组 34 5.00±1.10 2.91±0.83
t值   0.363 4.897
P值   >0.05 <0.05
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