腹腔镜与开放式巨大腹壁切口疝补片修补术的对比分析_医学论文.docVIP

腹腔镜与开放式巨大腹壁切口疝补片修补术的对比分析_医学论文 腹腔镜与开放式巨大腹壁切口疝补片修补术的对比分析_医学论文 作者：杨福全，刘 源，赵海鹰，田忠，李航宇，耿东华，乔麟，刘金钢【摘要】 目的：比较开放手术及腹腔镜补片修补巨大腹壁切口疝的手术效果。方法：回顾分析我院2003年1月至2007年6月收治的43例巨大腹壁切口疝患者的临床资料。根据手术方式分为腹腔镜组（16例）和开放组（27例），对两组手术时间、术后并发症、术后住院时间等进行对比分析。结果：两组手术时间、术后并发症发生率无明显差异。开放手术组2例发生切口感染，1例经冲洗引流2个月治愈，另1例再次手术取出补片。腹腔镜手术组术后住院时间和手术出血量明显少于开放手术组。术后随访4～48个月，平均21个月，两组均无复发病例。结论：腹腔镜下应用补片修补巨大腹壁切口疝同样安全、合理，且具有患者创伤小、康复快和术后住院时间短等优点。 【关键词】 疝，腹；切口疝；疝修补术；腹腔镜术 【Abstract】 Ｏbjective:To analyze and compare the effect of open and laparoscopic mesh repair of huge incisional hernia.Methods:The clinical data of 43 cases with huge incisional hernia which underwent open and laparoscopic mesh repair from Jan.2003 to Jun.2007 was retrospectively aralyzed.The patients were divided into two groups:laparoscopy group（16 cases ）and open (27 cases) group.The including operation time,complications and postoperative hospitalization were compared between the two groups.Results:There was no significant difference between the two groups in operative time and postoperative complications.But the postoperative hospitalization of open procedure group was longer than that of laparoscopic group（P＜0.0１）.The amount of bleeding during operation in open procedure was more than that in laparoscopic procedure.There was no recurrence in two groups during a followup of 448m(mean 21m).Conclusions:Open and laparoscopic mesh repair procedure are both safe and valid methods in the treatment of huge incisional hernia.Laparoscopic mesh repair has the advantages of minimal invasive,quick recovery and short postoperotive hosptalization. 【Key words】 Hernia,ventralIncisional herniaHerniorrhaphyLaparoscopy 腹壁切口疝是腹部外科手术后常见的并发症，文献报道［１］，腹壁切口疝的发生率为3%～20%。巨大腹壁切口疝直接缝合修补术后复发率高达24%～54%［２］，既给患者的生活、工作带来痛苦，也给外科治疗造成很大困难。应用合成材料修补腹壁切口疝效果好、复发率低，逐渐得到了国内外学者的认同［３］。根据补片植入的方式可分为开放手术和腹腔镜修补术。随着腹腔镜技术的发展，微创手术修补切口疝逐步开展起来。现将我院43例疝环长径在10cm以上的巨大切口疝应用合成材料行开放手术和腹腔镜修补术的结果报道如下，并结合国内外文献进行对比分析。 1 资料与方法 1.1 临床资料 2003年1月至2007年6月我院共收治巨大切口疝患者43例，其中腹腔镜修补16例，开放式补片植入27例。患者35～72岁，平均58岁。男