腹腔镜腹腔内补片修补术治疗腹壁疝补片固定方法的选择与应用

doi:10.3877/cma.j.issn.1674-392X.2023.03.008

目的

探讨多种补片固定方法在腹腔镜腹腔内补片修补术（IPOM）治疗腹壁疝中的应用。

方法

回顾性分析2015年7月1日至2020年7月31日，在嵊州市人民医院疝腹壁外科行IPOM手术的52例腹壁疝患者的病例资料，根据补片固定方法的不同，将其分为A组、B组与C组：A组采用疝钉固定法（20例），B组采用缝线固定法（15例），C组采用钉线联合法（17例）。比较分析各组患者的手术时间、补片固定时间、住院总费用、术后住院时间以及术后并发症情况。

结果

52例腹壁疝患者均顺利完成手术。A组的手术时间短于B组和C组，B组的手术时间短于C组，差异均有统计学意义（P<0.05）；A组的补片固定时间短于B组和C组，B组的补片固定时间长于C组，差异均有统计学意义（P<0.05）；B组的术后住院时间短于A组和C组，A组的术后住院时间短于C组，差异均有统计学意义（P<0.05）；B组的住院总费用低于A组和C组，A组的住院总费用低于C组，差异均有统计学意义（P<0.05）。术后出现疼痛8例，发热5例，咳嗽8例，未出现腹腔室间隔综合征、出血、肠瘘、肠梗阻、补片感染、复发等并发症。3组患者术后疼痛、发热、咳嗽发生率组间对比差异均无统计学意义（P>0.05）。

结论

本研究发现用IPOM术式治疗腹壁疝时，几种补片固定方法各有特点，A组手术及补片固定用时短，但费用较高；B组损伤小，恢复快，费用低，但用时较A组稍长；C组从时间和费用方面并不具备优势，但适用于腹壁缺损较大的患者。临床应个体化合理选择最佳的补片固定方法，以确保疗效，提高患者的生活质量和满意度。

关键词: 腹壁疝, 疝修补术, 补片, 固定方法

Objective

To investigate the application of various mesh fixation methods in laparoscopic intraperitoneal onlay mesh (IPOM) for the treatment of abdominal wall hernia.

Methods

A retrospective analysis was conducted using data of 52 patients with abdominal wall hernia, who underwent IPOM surgery in the Department of Hernia and Abdominal Wall Surgery, Shengzhou People's Hospital from July 1, 2015 to July 31, 2020. According to different mesh fixation methods, they were divided into Group A, Group B, and Group C. Group A used hernia tack fixation method (20 cases), Group B used suture fixation method (15 cases), and Group C used tack-suture combination method (17 cases). The surgical time, mesh fixation time, total hospitalization cost, postoperative hospitalization time, and postoperative complications of each group of patients were compared and analyzed.

Results

All 52 patients with abdominal wall hernia successfully completed the operation. The surgical time of Group A was shorter than that of Group B and Group C, and the surgical time of Group B was shorter than that of Group C, with statistical significance (P<0.05). The mesh fixation time of Group A was shorter than that of Group B and Group C, while the mesh fixation time of Group B was longer than that of Group C, with statistical significance (P<0.05). The postoperative hospitalization time of Group B was shorter than that of Group A and Group C, and the postoperative hospitalization time of Group A was shorter than that of Group C, with statistical significance (P<0.05). The total hospitalization expenses of Group B were lower than that of Group A and Group C. The total hospitalization cost of Group A was lower than that of Group C, and the difference was statistically significant (P<0.05). There were 8 cases of postoperative pain, 5 cases of fever, and 8 cases of cough. There were no complications such as abdominal compartment syndrome, bleeding, intestinal fistula, intestinal obstruction, mesh infection, and recurrence. There was no statistically significant difference in the incidence of postoperative pain, fever, and cough among the three groups of patients (P>0.05).

Conclusion

This study found that in the treatment of abdominal wall hernia with IPOM, several mesh fixation methods have their own characteristics. The operation and mesh fixation time in group A are short, but the cost is high. Group B had less damage, faster recovery and lower cost, but the time was longer than group A. Group C has no advantage in time and cost, but it is suitable for patients with large abdominal wall defects. Due to individual differences in patients, the optimal mesh fixation method should be selected individually and reasonably in clinical practice, in order to ensure surgical efficacy and improve patients' quality of life and satisfaction.

Key words: Abdominal wall hernia, Herniorrhaphy, Mesh, Fixation method

图1 腹腔镜下疝钉均匀、平整地固定补片

图2 术中2枚疝钉滑脱（黄色箭头），予缝合加固

表1 3组患者一般资料比较（±s）

组别	例数	年龄(岁)	体重指数(kg/m²)	病程(月)	腹壁缺损大小(cm)
A组	20	58.4±13.3	24.9±3.6	80.1±186.0	3.8±2.2
B组	15	50.3±12.5	26.7±2.8	71.4±166.3	2.4±0.9
C组	17	61.0±7.3	24.8±2.9	7.9± 5.6	6.1±2.2
F值		2.037	0.929	0.674	7.778
P值		0.152	0.409	0.519	0.002

表1 3组患者一般资料比较（±s）

组别	例数	年龄(岁)	体重指数(kg/m²)	病程(月)	腹壁缺损大小(cm)
A组	20	58.4±13.3	24.9±3.6	80.1±186.0	3.8±2.2
B组	15	50.3±12.5	26.7±2.8	71.4±166.3	2.4±0.9
C组	17	61.0±7.3	24.8±2.9	7.9± 5.6	6.1±2.2
F值		2.037	0.929	0.674	7.778
P值		0.152	0.409	0.519	0.002

表2 3组患者手术相关指标比较[中位数（四分位距）]

组别	例数	手术时间(min)	补片固定时间(min)	术后住院时间(d)	住院总费用(元)
A组	20	85.0(30.0)	5.5(3.0)	4.5(4.0)	22 843.9(11 340.1)
B组	15	90.0(56.0)	24.5(15.0)	4.0(2.0)	16 310.9(9761.2)
C组	17	150.0(183.0)	16.0(6.0)	8.0(2.0)	37 763.7(12 212.8)
H值		3.799	20.300	15.048	17.112
P值		0.032	0.000	0.003	0.000

表2 3组患者手术相关指标比较[中位数（四分位距）]

组别	例数	手术时间(min)	补片固定时间(min)	术后住院时间(d)	住院总费用(元)
A组	20	85.0(30.0)	5.5(3.0)	4.5(4.0)	22 843.9(11 340.1)
B组	15	90.0(56.0)	24.5(15.0)	4.0(2.0)	16 310.9(9761.2)
C组	17	150.0(183.0)	16.0(6.0)	8.0(2.0)	37 763.7(12 212.8)
H值		3.799	20.300	15.048	17.112
P值		0.032	0.000	0.003	0.000

表3 3组患者术后并发症发生情况比较[例（%）]

组别	例数	术后并发症
组别	例数	疼痛	发热	咳嗽
A组	20	3(15.00)	1(5.00)	2(10.00)
B组	15	1(6.67)	1(6.67)	3(20.00)
C组	17	4(23.53)	3(17.65)	3(17.65)
χ²值		5.021	2.628	2.628
P值		1.000	1.000	1.000

表3 3组患者术后并发症发生情况比较[例（%）]

组别	例数	术后并发症
组别	例数	疼痛	发热	咳嗽
A组	20	3(15.00)	1(5.00)	2(10.00)
B组	15	1(6.67)	1(6.67)	3(20.00)
C组	17	4(23.53)	3(17.65)	3(17.65)
χ²值		5.021	2.628	2.628
P值		1.000	1.000	1.000

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Selection and application of mesh fixation methods in laparoscopic intraperitoneal onlay mesh for the treatment of abdominal wall hernia

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Selection and application of mesh fixation methods in laparoscopic intraperitoneal onlay mesh for the treatment of abdominal wall hernia