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

[1]	顾岩, 田文, 王平, 等. 腹壁缺损修复与重建中国专家共识(2019版)[J]. 中国实用外科杂志, 2019, 39(2): 101-109.
[2]	王平, 黄永刚, 高国栋, 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(五)[J/OL]. 中华疝和腹壁外科杂志(电子版), 2019, 13(6): 492-496.
[3]	Bittner R, Bingener-Casey J, Dietz U, et al. Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias(International Endohernia Society(IEHS)-part 1[J]. Surg Endosc, 2014, 28(1): 2-29.
[4]	比兵，车晓明.视觉模拟评分法(VAS)[J]. 中华神经外科杂志，2012, 28(6): 645-645.
[5]	唐健雄, 李绍杰, 李绍春. 对我国疝与腹壁外科专业发展的思考[J]. 中华消化外科杂志, 2021, 20(1): 98-101.
[6]	黄永刚, 叶静, 金华, 等. 肝胆胰手术后切口疝修补术的难点与进展[J]. 中华消化外科杂志, 2022, 21(9): 1234-1239.
[7]	李基业. 2014年《国际腔镜疝学会腹腔镜腹壁疝和切口疝治疗指南》解读[J]. 中国实用外科杂志, 2015, 35(11): 1206-1208.
[8]	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.
[9]	Holihan JL, Askenasy EP, Greenberg JA, et al. Component Separation vs. Bridged Repair for Large Ventral Hernias: A Multi-Institutional Risk-Adjusted Comparison, Systematic Review, and Meta-Analysis[J]. Surg Infect(Larchmt), 2016, 17(1): 17-26.
[10]	Sharma A, Berger D. The current role of laparoscopic IPOM repair in abdominal wall reconstruction[J]. Hernia, 2018, 22(5): 739-741.
[11]	陈双, 江志鹏. 切口疝、腹壁力学与外科技术[J]. 中国普通外科杂志, 2023, 32(10): 1-7.
[12]	Reynvoet E, Berrevoet F. Pros and cons of tacking in laparoscopic hernia repair[J]. Surg Technol Int, 2014, 25: 136-140.
[13]	邵煜奇, 王敏娟. 腹腔镜下腹壁切口疝的治疗及并发症预防研究进展[J/OL]. 中华疝和腹壁外科杂志(电子版), 2021, 15(3): 312-315.
[14]	唐健雄, 郑民华, 田文, 等. 切口疝腹腔镜手术的规范化操作专家共识[J/OL]. 中华疝和腹壁外科杂志(电子版), 2016, 10(1): 1-7.
[15]	Khan RMA, Bughio M, Ali B, et al. Absorbable versus non-absorbable tacks for mesh fixation in laparoscopic ventral hernia repair: A systematic review and meta-analysis[J]. Int J Surg, 2018, 53: 184-192.
[16]	Christoffersen MW, Brandt E, Helgstrand F, et al. Recurrence rate after absorbable tack fixation of mesh in laparoscopic incisional hernia repair[J]. Br J Surg, 2015, 102(5): 541-547.
[17]	Bansal VK, Asuri K, Panaiyadiyan S, et al. Comparison of Absorbable Versus Nonabsorbable Tackers in Terms of Long-term Outcomes, Chronic Pain, and Quality of Life After Laparoscopic Incisional Hernia Repair: A Randomized Study[J]. Surg Laparosc Endosc Percutan Tech, 2016, 26(6): 476-483.
[18]	Brill JB, Turner PL. Long-term outcomes with transfascial sutures versus tacks in laparoscopic ventral hernia repair: a review[J]. Am Surg, 2011, 77(4): 458-465.
[19]	Köckerling F, Lammers B, Weyhe D, et al. What is the outcome of the open IPOM versus sublay technique in the treatment of larger incisional hernias? A propensity score-matched comparison of 9091 patients from the Herniamed Registry[J]. Hernia, 2021, 25(1): 23-31.
[20]	Mitura K. Different approach to laparoscopic IPOM ventral hernia surgery-what has the last decade taught us?[J]. Pol Przegl Chir, 2016, 88(1): 54-61.
[21]	曹耀权, 朱晒红, 朱利勇. 达芬奇机器人辅助下腹腔内补片植入术治疗腹壁切口疝[J]. 中华胃肠外科杂志, 2022, 25(10): 905.
[22]	Van't Riet M, de Vos vain Steenwijk PJ, Kleinrensink GJ, et a1. Tensile strength of mesh fixation methods in laparoscopic incisional hernia repair[J]. Surg Endosc, 2002, 16(12): 1713-1716.
[23]	Misiakos EP, Patapis P, Zavras N, et al. Current Trends in Laparoscopic Ventral Hernia Repair[J]. JSLS, 2015, 19(3): 1-11.
[24]	Reynvoet E, Deschepper E, Rogiers X, et al. Laparoscopic ventral hernia repair: is there an optimal mesh fixation technique? A systematic review[J]. Langenbecks Arch Surg, 2014, 399(1): 55-63.
[25]	Wilson P. Laparoscopic intraperitoneal onlay mesh(IPOM) repair using n-butyl-2-cyanoacrylate(Liquiband Fix8™) for mesh fixation: learning experience and short-medium term results[J]. Hernia, 2020, 24(6): 1387-1396.
[26]	Bittner R, Bain K, Bansal VK, et al. Update of Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias(International Endohernia Society(IEHS))-Part A[J]. Surg Endosc, 2019, 33(10): 3069-3139.
[27]	Li J, Zhang W. Mesh fixation in IPOM with glue, a matter of solution?[J]. Hernia, 2021, 25(1): 229-230.
[28]	Schug-Pass C, Lippert H, Köckerling F. Fixation of mesh to the peritoneum using a fibrin glue: investigations with a biomechanical model and an experimental laparoscopic porcine model[J]. Surg Endosc, 2009, 23(12): 2809-2815.
[29]	Bellido Luque JA, Bellido Luque A, Gomez Menchero J, et al. Safety and effectiveness of self-adhesive mesh in laparoscopic ventral hernia repair using transabdominal preperitoneal route[J]. Surg Endosc, 2017, 31(3): 1213-1218.
[30]	Bansal VK, Misra MC, Kumar S, et al. A prospective randomized study comparing suture mesh fixation versus tacker mesh fixation for laparoscopic repair of incisional and ventral hernias[J]. Surg Endosc, 2011, 25(5): 1431-1438.
[31]	Bittner R, Bingener-Casey J, Dietz U, et al. Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias(International Endohernia Society[IEHS])—Part 2[J]. Surg Endosc, 2014, 28(2): 353-379.
[32]	Muysoms F, Vander Mijnsbrugge G, Pletinckx P, et al. Randomized clinical trial of mesh fixation with "double crown" versus "sutures and tackers" in laparoscopic ventral hernia repair[J]. Hernia, 2013, 17(5): 603-612.
[33]	Chatzimavroudis G, Kalaitzis S, Voloudakis N, et al. Evaluation of four mesh fixation methods in an experimental model of ventral hernia repair[J]. J Surg Res, 2017, 212: 253-259.

[1]	刘柏隆, 周祥福. 经阴道膀胱膨出前盆补片修补术 + 阴道后壁修补术[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2025, 19(01): 128-128.
[2]	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.
[3]	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.
[4]	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.
[5]	曹能琦, 张恒, 郑立锋, 陶庆松, 嵇振岭. Ad-Hoc 自裁剪补片用于造口旁疝Sugarbaker 修补术[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 620-623.
[6]	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.
[7]	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.
[8]	王浩源, 汪海洋, 孙建明, 陈以宽, 祁小桐, 唐博. 腹腔镜与开放修补对肝硬化腹外疝患者肝功能及凝血的影响[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 654-659.
[9]	周正阳, 陈凯, 仇多良, 邵乐宁, 吴浩荣, 钟丰云. 腹腔镜腹股沟疝修补术后出血原因分析及处理[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 660-664.
[10]	顾熙, 徐子宇, 周澍, 张吴楼, 张业鹏, 林昊, 刘宗航, 嵇振岭, 郑立锋. 腹股沟疝腹膜前间隙无张力修补术后补片感染10 例报道[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 665-669.
[11]	宋俊锋, 张珍珍. 单侧初发性腹股沟斜疝老年患者经腹腹膜前疝修补术中残余疝囊腹直肌下缘固定效果评估[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 670-674.
[12]	高娟, 徐建庆, 闫芳, 丁盛华, 刘霞. Rutkow、TAPP、TEP 手术治疗单侧腹股沟疝患者的临床疗效及对血清炎症因子水平的影响[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 675-680.
[13]	于新峰, 曾琦, 后强, 徐浩, 操谢芳. 腹腔镜经腹腹膜前疝修补术和腹腔镜完全腹膜外疝修补术对成人腹股沟疝治疗效果及预后分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 681-686.
[14]	臧宇, 姚胜, 朱新勇, 戎世捧, 田智超. 低温等离子射频消融治疗腹壁疝术后补片感染的临床效果[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 687-692.
[15]	杨闯, 马雪. 腹壁疝术后感染的危险因素分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 693-696.

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

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

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