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中华疝和腹壁外科杂志(电子版) ›› 2023, Vol. 17 ›› Issue (04) : 437 -440. doi: 10.3877/cma.j.issn.1674-392X.2023.04.015

论著

腹腔镜完全腹膜外疝修补术治疗腹壁切口疝的临床疗效
刘文宇()   
  1. 100730 首都医科大学附属北京同仁医院手术室
  • 收稿日期:2023-05-22 出版日期:2023-08-18
  • 通信作者: 刘文宇
  • 基金资助:
    首都医科大学教育教学改革研究课题(2022JYY392)

Clinical efficacy of laparoscopic totally extra-peritoneal hernia repair for incisional hernia of the abdominal wall

Wenyu Liu()   

  1. Operating Room, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
  • Received:2023-05-22 Published:2023-08-18
  • Corresponding author: Wenyu Liu
引用本文:

刘文宇. 腹腔镜完全腹膜外疝修补术治疗腹壁切口疝的临床疗效[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(04): 437-440.

Wenyu Liu. Clinical efficacy of laparoscopic totally extra-peritoneal hernia repair for incisional hernia of the abdominal wall[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2023, 17(04): 437-440.

目的

探讨腹腔镜完全腹膜外疝修补术(TEP)治疗腹壁切口疝的临床疗效。

方法

选择2022年4月至2023年4月,于首都医科大学附属北京同仁医院拟行腹壁切口疝患者138例。依据手术方式的不同分为腹腔镜组,54例,实施TEP,对照组84例,采用开放性补片修补术。对比分析两组患者的围手术期情况及术后1周复发率。

结果

腹腔镜组并发症(切口愈合不良、切口感染、阴囊水肿、阴囊血肿、尿潴留及异物感硬结)发生率低于对照组,差异有统计学意义(P<0.05)。腹腔镜组的手术时间、住院时间、术中出血量及复发率低于对照组,差异有统计学意义(P<0.05)。腹腔镜组术后24 h疼痛视觉模拟评分(VAS)低于对照组,差异有统计学意义(P<0.05),48 h VAS评分两组比较差异无统计学意义。

结论

TEP治疗腹壁切口疝具有手术时间短、创伤小、术后恢复快、并发症少等安全可靠的优点。

Objective

To investigate the clinical efficacy of laparoscopic totally extra-peritoneal hernia repair (TEP) for incisional hernia of the abdominal wall.

Methods

A total of 138 patients with incisional hernia of the abdominal wall were selected from April 2022 to April 2023 in Beijing Tongren Hospital, Capital Medical University. According to different surgical methods, 54 patients who underwent TEP were divided into the laparoscopic group and 84 patients who underwent open mesh repair were divided into the control group. The differences between the two groups were compared in terms of perioperative condition and recurrence rate one week after operation.

Results

The patients in the laparoscopic group had lower incidence of complications (poor incisional healing, incisional infection, scrotal edema, scrotal hematoma, urinary retention and foreign body sensation hardening) than the control group, and the difference was statistically significant (P<0.05). The operative time, hospital stay, intraoperative bleeding, and recurrence rate were lower in the laparoscopic group than those in the control group, with statistically significant differences (P<0.05). The visual analogue scale (VAS) scores were lower in the laparoscopic group than that in the control group at 24 h postoperatively, with statistically significant differences (P<0.05). There was no significant difference in VAS score between the two groups at 48 hours after operation.

Conclusion

Laparoscopic TEP hernia repair was safe and reliable, with the advantages of short operation time, less trauma, rapid postoperative recovery, and few complications.

表1 两组患者一般资料比较[例(%)]
表2 两组患者术后并发症比较
表3 两组患者手术效果比较(±s
[1]
Li J, Wang Y, Wu L. The Comparison of eTEP and IPOM in Ventral and Incisional Hernia Repair: A Systematic Review and Meta-analysis[J]. Surg Laparosc Endosc Percutan Tech, 2022, 32(2): 252-258.
[2]
Parker SG, Mallett S, Quinn L, et al. Identifying predictors of ventral hernia recurrence: systematic review and meta-analysis[J]. BJS Open, 2021, 5(2): zraa071.
[3]
Ma N, Tang D, Tang FX, et al. Application of a New Mesh Fixation Method in Laparoscopic Incisional Hernia Repair[J]. J Vis Exp, 2022, (190).
[4]
Gómez-Menchero J, Balla A, Fernández Carazo A, et al. Primary closure of the midline abdominal wall defect during laparoscopic ventral hernia repair: analysis of risk factors for failure and outcomes at 5 years follow-up[J]. Surg Endosc, 2022, 36(12): 9064-9071.
[5]
王志刚, 王洪波. 腹腔镜术式治疗成年腹壁切口疝患者的疗效以及预后分析[J]. 山西医药杂志, 2018, 47(15): 3.
[6]
Baur J, Ramser M, Keller N, et al. Robotic hernia repair II. English version: Robotic primary ventral and incisional hernia repair(rv-TAPP and r-Rives or r-TARUP). Video report and results of a series of 118 patients[J]. Chirurg, 2021, 92(Suppl 1): 15-26.
[7]
罗文, 王勇, 段鑫. 腹腔镜联合开腹修补手术治疗造口旁疝27例疗效分析[J]. 中华外科杂志, 2017, 55(7): 4.
[8]
Brashear JM, LeBlanc KA. Insufflation Effects on the Abdominal Wall Dimensions and Incisional-Ventral Hernia Orifice Size[J]. J Surg Res, 2019, 243: 274-280.
[9]
Petro CC, Zolin S, Krpata D, et al. Patient-Reported Outcomes of Robotic vs Laparoscopic Ventral Hernia Repair With Intraperitoneal Mesh: The PROVE-IT Randomized Clinical Trial[J]. JAMA Surg, 2021, 156(1): 22-29.
[10]
李健文, 乐飞. 腹腔镜腹壁切口疝修补术并发症演变及防治[J]. 中国实用外科杂志, 2020, 40(7): 4.
[11]
Van den Dop LM, De Smet GHJ, Kleinrensink GJ, et al. Hybrid operation technique for incisional hernia repair: a systematic review and meta-analysis of intra- and postoperative complications[J]. Hernia, 2021, 25(6): 1459-1469.
[12]
Soliani G, De Troia A, Pesce A, et al. Predictive Factors of Recurrence After Laparoscopic Incisional Hernia Repair: A Retrospective Multicentre Cohort Study[J]. J Laparoendosc Adv Surg Tech A, 2023, 33(5): 427-433.
[13]
王京立, 华玉明, 朱从元. 腹腔镜或杂交技术修补大型、巨大型腹壁切口疝的技巧[J]. 中国微创外科杂志, 2017, 17(3): 3.
[14]
Henriksen NA, Friis-Andersen H, Jorgensen LN, et al. Open versus laparoscopic incisional hernia repair: nationwide database study[J]. BJS Open, 2021, 5(1): zraa010.
[15]
Maemoto R, Tsujinaka S, Kakizawa N, et al. Laparoscopic repair of suprapubic incisional hernia using a modified transabdominal partial extraperitoneal technique[J]. Asian J Endosc Surg, 2022, 15(4): 872-876.
[16]
Hoffmann H, Köckerling F, Adolf D, et al. Analysis of 4, 015 recurrent incisional hernia repairs from the Herniamed registry: risk factors and outcomes[J]. Hernia, 2021, 25(1): 61-75.
[17]
章晓娟, 吉沥, 刘海露. 腹腔镜下与经下腹部正中切口疝无张力修补术治疗成人腹股沟斜疝临床疗效分析[J]. 临床军医杂志, 2019,(6): 3.
[18]
Ali F, Sandblom G, Wikner A, et al. Laparoscopic ventral and incisional hernia repair using intraperitoneal onlay mesh with peritoneal bridging[J]. Hernia, 2022, 26(2): 635-646.
[19]
Todros S, Pachera P, Baldan N, et al. Computational modeling of abdominal hernia laparoscopic repair with a surgical mesh[J]. Int J Comput Assist Radiol Surg, 2018, 13(1): 73-81.
[20]
Tazaki T, Okamoto N, Sasaki M, et al. Laparoscopy-assisted repair with Ventralex ST Hernia Patch for a small subcostal hernia: A case report[J]. Asian J Endosc Surg, 2021, 14(1): 132-135.
[21]
LeBlanc KA, Gonzalez A, Dickens E, et al. Robotic-assisted, laparoscopic, and open incisional hernia repair: early outcomes from the Prospective Hernia Study[J]. Hernia, 2021, 25(4): 1071-1082.
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