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

doi:10.3877/cma.j.issn.1674-392X.2021.06.017

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

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

[1]	刘亦婷，陈杰，申英末. 腹壁疝中补片固定方式的演变及研究进展[J/OL]. 中华疝和腹壁外科杂志(电子版), 2018, 12(6): 406-408.
[2]	Ahmed M, Mehboob M. Comparisons of onlay versus sublay mesh fixation technique in ventral abdominal wall incisional hernia repair[J]. J Coll Physicians Surg, 2019, 29(9): 819-822.
[3]	Alizai PH, Lelaona E, Andert A, et al. Incisional hernia repair of medium-and large-sized defects: laparoscopic IPOM versus open SUBLAY technique[J]. Acta Chirurgica Belgica, 2019, 119(9): 231-235.
[4]	中华医学会外科学分会疝与腹壁外科学组，中国医师协会外科医师分会疝和腹壁外科医师委员会. 腹壁切口疝诊断和治疗指南(2018年版)[J]. 中华胃肠外科志, 2018, 21(7): 725-728.
[5]	Stoppa RE．The treatment of complicated groin and incisional hernias[J]. World J Surg, 1989, 13(5): 545-554.
[6]	汤睿，吴卫东. 切口疝的腹腔镜Sublay修补术[J]. 腹腔镜外科志, 2018, 23(10): 721-724.
[7]	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.
[8]	Muysoms FE, Antoniou SA, Bury K, et al. European Hernia Society guidelines on the closure of abdominal wall incisions[J]. Hernia, 2015, 19(1): 1-24.
[9]	Israelsson LA, Jonsson T. Suture length to wound length ratio and healing of midline laparotomy incisions[J]. Br J Surg, 1993, 80(10): 1284-1286.
[10]	Millbourn D, Wimo A, Israelsson LA. Cost analysis of the use of small stitches when closing midline abdominal incisions[J]. Hernia, 2014, 18(6): 775-780.
[11]	LeBlanc KA, Booth WV. Laparoscopic repair of incisional abdominal hernias using expanded polytetrafluoroethy lene: preliminary findings[J]. Surg Laparosc Endosc, 1993, 3(1): 39-41.
[12]	Lavanchy JL, Buff SE, Kohler A, et al. Long-term results of laparoscopic versus open intraperitoneal onlay mesh incisional hernia repair: a propensity score-matched analysis[J]. Surg Endosc, 2019, 33(1): 225-233.
[13]	Al Chalabi H, Larkin J, Mehigan B, et al. A systematic review of laparoscopic versus open abdominal incisional hernia repair, with meta-analysis of randomized controlled trials[J]. Int J Surg, 2015, 20(5): 65-74.
[14]	Moreno-Egea A, Carrillo-Alcaraz A, Aguayo-Albasini JL. Is the outcome of laparoscopic incisional hernia repair affected by defect size? A prospective study[J]. Am J Surg, 2012, 203(1): 87-94.
[15]	Awaiz A, Rahman F, Hossain MB, et al. Meta-analysis and systematic review of laparoscopic versus open mesh repair for elective incisional hernia[J]. Hernia, 2015, 19(3): 449-463.
[16]	杨慧琪，陈杰，赵营, 等. 国际内镜疝学会腹壁疝和切口疝腹腔镜治疗指南更新解读(二)[J/OL]. 中华疝和腹壁外科杂志(电子版), 2019, 13(5): 389-391.
[17]	Ahonen-Siirtola M, Nevala T, Vironen J, et al. Laparoscopic versus hybrid approach for treatment of incisional ventral hernia: a prospective randomised multicentre study, 1-year results[J]. Springer Open Choice, 2020, 34(1): 88-95.
[18]	Kokotovic D, Bisgaard T, Helgstrand F. Long-term recurrence and complications associated with elective incisional hernia repair[J]. JAMA, 2016, 316(15): 1575-1582.
[19]	帕尔哈提·阿布都热衣木，孙琴琴，张军, 等. 腹直肌后置入补片治疗腹壁切口疝59例[J/OL]. 中华疝和腹壁外科杂志(电子版), 2013, 7(4): 349-351.
[20]	Krpata DM, Prabhu AS, Carbonell AM, et al. Drain placement does not increase infectious complications after retromuscular ventral hernia repair with synthetic mesh: an AHSQC analysis[J]. J Gastrointest Surg, 2017, 21(12): 2083-2089.
[21]	Basoglu M, Yildirgan MI, Yilmaz I, et al. Late complications of incisional hernias following prosthetic mesh repairl[J]. Acta Chirurgica Belgica, 2004, 104(4): 425-428.
[22]	谢颂状，克力木·阿不都热依木，李赞林. 腹壁切口疝发病诱因与治疗研究进展[J]. 中华实用诊断与治疗杂志, 2016, 30(10): 946-949.

[1]	李刘庆, 陈小翔, 吕成余. 全腹腔镜与腹腔镜辅助远端胃癌根治术治疗进展期胃癌的近中期随访比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 23-26.
[2]	刘世君, 马杰, 师鲁静. 胃癌完整系膜切除术+标准D2根治术治疗进展期胃癌的近中期随访研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 27-30.
[3]	赵丽霞, 王春霞, 陈一锋, 胡东平, 张维胜, 王涛, 张洪来. 内脏型肥胖对腹腔镜直肠癌根治术后早期并发症的影响[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 35-39.
[4]	李华志, 曹广, 刘殿刚, 张雅静. 不同入路下行肝切除术治疗原发性肝细胞癌的临床对比[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 52-55.
[5]	常小伟, 蔡瑜, 赵志勇, 张伟. 高强度聚焦超声消融术联合肝动脉化疗栓塞术治疗原发性肝细胞癌的效果及安全性分析[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 56-59.
[6]	徐逸男. 不同术式治疗梗阻性左半结直肠癌的疗效观察[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 72-75.
[7]	王露, 周丽君. 全腹腔镜下远端胃大部切除不同吻合方式对胃癌患者胃功能恢复、并发症发生率的影响[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 92-95.
[8]	许杰, 李亚俊, 冯义文. SOX新辅助化疗后腹腔镜胃癌D2根治术与常规根治术治疗进展期胃癌的近期随访比较[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 647-650.
[9]	刘柏隆, 周祥福. 女性尿失禁吊带手术并发症处理的经验分享[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2025, 19(01): 127-127.
[10]	嵇振岭, 陈杰, 唐健雄. 重视复杂腹壁疝手术并发症的预防和处理[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 601-606.
[11]	江志鹏, 钟克力, 陈双. 复杂腹壁疝手术后腹腔高压与腹腔间室综合征的预防和处理[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 612-615.
[12]	王学虎, 赵渝. 复杂腹壁疝手术中血管损伤并发症的预防和处理[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 616-619.
[13]	皮尔地瓦斯·麦麦提玉素甫, 李慧灵, 艾克拜尔·艾力, 李赞林, 王志, 克力木·阿不都热依木. 生物补片修补巨大复发性腹壁切口疝临床疗效分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 624-628.
[14]	马东扬, 李斌, 陆安清, 王光华, 雷文章, 宋应寒. Gilbert 与单层补片腹膜前疝修补术疗效的随机对照研究[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 629-633.
[15]	林凯, 潘勇, 赵高平, 杨春. 造口还纳术后切口疝的危险因素分析与预防策略[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 634-638.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

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

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

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