目的 分析杂交手术、腹腔镜手术和开放手术治疗腹壁切口疝临床效果。方法 回顾性分析2018年1月—2021年12月收治的90例腹壁切口疝患者临床资料,按照术式分为杂交组、腹腔镜组和开放组,每组各30例。比较三组手术时间、术中出血量、住院时间和术后并发症发生情况。结果 三组手术时间、术中出血量、住院时间进行对比差异显著(P<0.05)。两两比较,杂交组手术时间显著长于腹腔镜组和开放组(P<0.05),腹腔镜组手术时间与开放组对比无统计学差异(P>0.05);杂交组术中出血量明显少于开放组(P<0.05),杂交组和腹腔镜组、腹腔镜组和开放组术中出血量进行对比无统计学差异(P>0.05);杂交组住院时间与腹腔镜组对比无统计学差异(P>0.05),短于开放组(P<0.05),腹腔镜组住院时间短于开放组(P<0.05)。三组比较,术后并发症差异显著(P<0.05)。结论 三种术式在治疗腹壁切口疝各有优劣,施术者应掌握各种术式的适应证,根据患者的实际情况选择合适的术式,以求达到最优的治疗途径和最佳的治疗效果。
Objective To analyze the clinical effects of hybrid surgery, laparoscopic surgery, and open surgery on abdominal incisional hernia. Methods The clinical data of 90 patients with abdominal incisional hernia admitted from January 2018 to December 2021 were retrospectively analyzed. According to the operation method, they were divided into hybrid group, laparoscopic group, and open group, with 30 cases in each group. Operation time, intraoperative blood loss, hospital stay, and postoperative complications were compared among the three groups. Results There were significant differences in operation time, intraoperative blood loss, and hospital stay among the three groups (P<0.05). Pairwise comparison results showed that the operation time of the hybrid group was significantly longer than those of the laparoscopic group and the open group (P<0.05), but there was no significant difference between the laparoscopic group and the open group (P>0.05). The amount of intraoperative blood loss in the hybrid group was significantly less than that in the open group (P<0.05). There was no significant difference in the amount of intraoperative blood loss between the hybrid group and the laparoscopic group, and between the laparoscopic group and the open group (P>0.05). There was no significant difference in the length of hospital stay between the hybrid group and the laparoscopic group (P>0.05), but both were shorter than that of the open group (P<0.05). There were significant differences in postoperative complications among the three groups (P<0.05). Conclusion The three surgical methods have their own advantages and disadvantages in the treatment of abdominal incisional hernia. Operators should understand the indications of various surgical methods and choose the appropriate surgical method according to the actual situation of the patient, so as to achieve the optimal treatment approach and the best therapeutic effects.
[1] 田广健, 刘鹏, 杨佩, 等. 开放手术辅助腹腔镜与完全腹腔镜下修补术治疗腹壁切口疝的临床研究[J]. 中华疝和腹壁外科杂志(电子版), 2020, 14(5): 481-484.
[2] 赵春, 姚宏芹. 杂交手术与腹腔镜下修补术治疗腹壁切口疝的临床研究[J]. 中华疝和腹壁外科杂志(电子版), 2019, 13(6): 537-539.
[3] Rosai J, Dehner LP.Nodular mesothelial hyperplasia in hernia sacs. A benign reactive condition simulating a neoplastic process[J]. Cancer, 2015, 35(1): 165-175.
[4] 杨天佑. 杂交技术治疗复杂切口疝的疗效分析 [D]. 江苏: 苏州大学, 2020.
[5] 中华医学会外科学分会疝和腹壁外科学组, 中国医师协会外科医师分会疝和腹壁外科医师委员会. 腹壁切口疝诊疗指南(2014年版)[J]. 中华外科杂志, 2014, 52(7): 485-488.
[6] 马丽梅. 腹腔镜疝修补术与开腹手术治疗腹部手术后腹壁切口疝疗效对比观察[J]. 中国医疗器械信息, 2018, 24(6): 93-94.
[7] 李军, 王磊, 柴大海, 等. 杂交技术治疗巨大腹壁切口疝的临床效果[J]. 宁夏医科大学学报, 2017, 39(6): 721-724.
[8] LeBlanc KA, Booth WV. Laparoscopic repair of incisional abdominal hernias using expanded polytetrafluoroethylene: preliminary findings[J]. Surg Laparosc Endosc, 1993, 3(1): 39-41.
[9] Lowe JB, Garza JR, Bowman JL, et al.Endoscopically assisted "components separation" for closure of abdominal wall defects[J]. Plast Reconstr Surg, 2000, 105(2): 720-729.