生物补片与自固定补片在腹股沟疝修补术中的临床对照研究

doi:10.3877/cma.j.issn.1674-392X.2022.05.011

目的

对比猪小肠黏膜下层脱细胞基质生物补片和自固定人工合成聚丙烯补片在腹股沟疝Lichtenstein修补术中应用的临床疗效。

方法

回顾性分析2019年5月至2020年4月于天津市南开医院胃肠疝外科行Lichtenstein修补术的96例初发单侧腹股沟疝患者的临床资料，按照修补材料不同分为SIS组（使用猪小肠黏膜下层脱细胞基质材料生物补片）和SGPP组（使用自固定人工合成聚丙烯补片）。对比2组的一般情况、手术情况及术后并发症情况，评价两种修补材料的安全性和临床疗效。

结果

SIS组46例，SGPP组50例，2组患者一般资料差异无统计学意义（P>0.05）。SIS组手术时间（62.61±6.89）min显著长于SGPP组（59.60±5.13）min（t=2.438，P=0.017）。2组在住院时间、术后第1天疼痛评分、血清肿、切口感染、复发、慢性疼痛、补片感染等方面，差异无统计学意义（P>0.05）。

结论

与自固定人工合成聚丙烯补片相比，猪小肠黏膜下层脱细胞基质生物补片应用于成人腹股沟疝Lichtenstein修补术具有相同的临床疗效及安全性，但其长期疗效仍有待进一步研究。

关键词: 疝，腹股沟, 疝修补术, 生物补片, 并发症

Objective

To compare the clinical efficacy of porcine small intestinal submucosal acellular matrix biological mesh and self-gripping synthetic polypropylene mesh in Lichtenstein repair of inguinal hernia.

Methods

The clinical data of 96 patients with primary unilateral inguinal hernia who underwent Lichtenstein repair in the Department of Gastrointestinal and Hernia Surgery of Tianjin Nankai Hospital from May 2019 to April 2020 were retrospectively analyzed.The patients were divided into the SIS group (using the porcine small intestinal submucosal acellular matrix biological mesh) and the SGPP group (using the self-gripping synthetic polypropylene mesh) according to the different repair materials. The general conditions, surgical conditions, and postoperative complications of the two groups were compared, and the safety and clinical efficacy of the two repair materials were evaluated.

Results

There were 46 cases in the SIS group and 50 cases in the SGPP group. There was no significant difference in the general data between the two groups (P>0.05). The operation time in the SIS group was significantly longer than that in the SGPP group [(62.61±6.89) min vs (59.60±5.13) min. t=2.438, P=0.017]. There was no significant difference between the two groups in hospital stay, pain score on the first postoperative day, seroma, incision infection, recurrence, chronic pain, and mesh infection (P>0.05).

Conclusion

Compared with the self-gripping synthetic polypropylene mesh, the porcine small intestinal submucosal acellular matrix biological mesh has the same clinical efficacy and safety in Lichtenstein repair of inguinal hernia in adults, but its long-term efficacy still needs to be further studied.

Key words: Hernia, inguinal, Herniorrhaphy, Biological mesh, Complication

表1 2组患者一般资料比较

组别	例数	性别[例(%)]		年龄(岁, ±s)	体质量指数(kg/m², ±s)	疝类别[例(%)]		中华医学会疝分型[例(%)]
组别	例数	男	女	年龄(岁, ±s)	体质量指数(kg/m², ±s)	斜疝	直疝	Ⅰ型	Ⅱ型	Ⅲ型	Ⅳ型
SIS组	46	44(95.7)	2(4.3)	36.69±12.21	23.73±3.17	37(80.4)	9(19.6)	18(39.1)	18(39.1)	10(21.7)	0
SGPP组	50	49(98.0)	1(2.0)	41.50±12.56	23.80±2.74	38(76.0)	12(24.0)	21(42.0)	18(36.0)	11(2.2)	0
t/χ²		0.436		1.897	0.114	0.276		0.112
P		0.606		0.061	0.910	0.630		0.965

表1 2组患者一般资料比较

组别	例数	性别[例(%)]		年龄(岁, ±s)	体质量指数(kg/m², ±s)	疝类别[例(%)]		中华医学会疝分型[例(%)]
组别	例数	男	女	年龄(岁, ±s)	体质量指数(kg/m², ±s)	斜疝	直疝	Ⅰ型	Ⅱ型	Ⅲ型	Ⅳ型
SIS组	46	44(95.7)	2(4.3)	36.69±12.21	23.73±3.17	37(80.4)	9(19.6)	18(39.1)	18(39.1)	10(21.7)	0
SGPP组	50	49(98.0)	1(2.0)	41.50±12.56	23.80±2.74	38(76.0)	12(24.0)	21(42.0)	18(36.0)	11(2.2)	0
t/χ²		0.436		1.897	0.114	0.276		0.112
P		0.606		0.061	0.910	0.630		0.965

表2 2组患者手术时间、住院时间、疼痛评分比较（±s）

组别	例数	手术时间(min)	住院时间(d)	术后第1天疼痛评分
SIS组	46	62.61±6.89	3.54±0.68	3.35±0.82
SGPP组	50	59.60±5.13	3.56±0.79	3.42±0.88
t值		2.438	0.109	0.413
P		0.017	0.913	0.68

表2 2组患者手术时间、住院时间、疼痛评分比较（±s）

组别	例数	手术时间(min)	住院时间(d)	术后第1天疼痛评分
SIS组	46	62.61±6.89	3.54±0.68	3.35±0.82
SGPP组	50	59.60±5.13	3.56±0.79	3.42±0.88
t值		2.438	0.109	0.413
P		0.017	0.913	0.68

表3 2组患者术后主要并发症情况比较[例（%）]

组别	例数	血清肿	切口感染	复发	慢性疼痛	补片感染	并发症发生率
SIS组	46	5(10.87)	1(2.17)	0	0	0	6(13.04)
SGPP组	50	2(4.00)	0	0	1(2.00)	0	3(6.00)
χ²		1.673	1.098	0.000	0.930	0.000	1.399
P		0.254	0.295	1.000	0.335	1.000	0.304

表3 2组患者术后主要并发症情况比较[例（%）]

组别	例数	血清肿	切口感染	复发	慢性疼痛	补片感染	并发症发生率
SIS组	46	5(10.87)	1(2.17)	0	0	0	6(13.04)
SGPP组	50	2(4.00)	0	0	1(2.00)	0	3(6.00)
χ²		1.673	1.098	0.000	0.930	0.000	1.399
P		0.254	0.295	1.000	0.335	1.000	0.304

[1]	HerniaSurge Group. International guidelines for groin hernia management[J]. Hernia, 2018, 22(1): 1-165.
[2]	Lockhart K, Dunn D, Teo S, et al. Mesh versus non-mesh for inguinal and femoral hernia repair[J]. Cochrane Database Syst Rev, 2018, 9(9): CD011517.
[3]	Cao G, Huang Y, Li K, et al. Small intestinal submucosa: superiority, limitations and solutions, and its potential to address bottlenecks in tissue repair[J]. J Mater Chem B, 2019, 7(33): 5038-5055.
[4]	中华医学会外科学分会疝与腹壁外科学组，中华医学会外科学分会腹腔镜与内镜外科学组，大中华腔镜疝外科学院. 腹腔镜腹股沟疝手术操作指南(2017版)[J/OL]. 中华疝和腹壁外科杂志(电子版), 2017, 11(6): 401-406.
[5]	Li B, Zhang X, Man Y, et al. Lichtenstein inguinal hernia repairs with porcine small intestine submucosa: a 5-year follow-up. a prospective randomized controlled study[J]. Regen Biomater, 2021, 8(1): rbaa055.
[6]	过文泰，胡民辉，黄榕康. 疝外科材料学百年发展及未来展望[J]. 中华胃肠外科杂志, 2018, 21(7): 828-832.
[7]	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.
[8]	Sun L, Chen J, Shen Y. Randomized Controlled Trial Of Lichtenstein Repair Of Indirect Inguinal Hernias With Two Biologic Meshes From Porcine Small Intestine Submucosa[J]. Ther Clin Risk Manag, 2019, 15: 1277-1282.
[9]	Ravo B, Falasco G. Pure tissue inguinal hernia repair with the use of biological mesh: a 10-year follows up. A prospective study[J]. Hernia, 2020, 24(1): 121-126.
[10]	He C, Lu J, Ong M W, et al. Seroma prevention strategies in laparoscopic ventral hernia repair: a systematic review[J]. Hernia, 2020, 24(4): 717-731.
[11]	Bochicchio G V, 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.
[12]	Takata H, Matsutani T, Hagiwara N, et al. Assessment of the incidence of chronic pain and discomfort after primary inguinal hernia repair[J]. J Surg Res, 2016, 206(2): 391-397.
[13]	Andresen K, Rosenberg J. Management of chronic pain after hernia repair[J]. J Pain Res, 2018, 11: 675-681.
[14]	Clancy C, Jordan P, Ridgway P F. Polypropylene mesh and systemic side effects in inguinal hernia repair: current evidence[J]. Ir J Med Sci, 2019, 188(4): 1349-1356.
[15]	Rutegård M, Lindqvist M, Svensson J, et al. Chronic pain after open inguinal hernia repair: expertise-based randomized clinical trial of heavyweight or lightweight mesh[J]. Br J Surg, 2021, 108(2): 138-144.
[16]	Forester B, Attaar M, Chirayil S, et al. Predictors of chronic pain after laparoscopic inguinal hernia repair[J]. Surgery, 2021, 169(3): 586-594.

[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]	康婵娟, 张海涛, 翟静洁. 胰管支架置入术治疗急性胆源性胰腺炎的效果及对患者肝功能、炎症因子水平的影响[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 667-670.
[9]	付成旺, 杨大刚, 王榕, 李福堂. 营养与炎症指标在可切除胰腺癌中的研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 704-708.
[10]	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.
[11]	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.
[12]	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.
[13]	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.
[14]	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.
[15]	石阳, 于剑锋, 曹可, 翟志伟, 叶春祥, 王振军, 韩加刚. 可扩张金属支架置入联合新辅助化疗治疗完全梗阻性左半结肠癌围手术期并发症分析[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 464-471.

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

Clinical comparative study of biological mesh and self-gripping mesh in inguinal hernia repair

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

Clinical comparative study of biological mesh and self-gripping mesh in inguinal hernia repair