外科理论与实践 ›› 2023, Vol. 28 ›› Issue (01): 67-71.doi: 10.16139/j.1007-9610.2023.01.11
何凯a, 唐颖b,*, 周秀玲c, 朱俞岚d, 傅晓键a, 朱炎逢b, 丁红c, 姚琪远a, 陈浩a()
收稿日期:
2022-05-24
出版日期:
2023-01-25
发布日期:
2023-03-25
通讯作者:
唐颖,陈浩
E-mail:fzjfl2019@163.com
基金资助:
HE Kaia, TANG Yingb,*, ZHOU Xiulingc, ZHU Yuland, FU Xiaojiana, ZHU Yanfengb, DING Hongc, YAO Qiyuana, CHEN Haoa()
Received:
2022-05-24
Online:
2023-01-25
Published:
2023-03-25
Contact:
TANG Ying,CHEN Hao
E-mail:fzjfl2019@163.com
摘要:
目的:回顾性研究腔镜腹白线折叠缝合术(endoscopic linea alba plication, ELAP)治疗产伤性腹直肌分离的临床疗效。方法:收集本院2018年1月至2021年12月采用ELAP治疗产伤性腹直肌分离病人的临床资料。共48例病人实施ELAP手术,1例失访,47例纳入研究。病人年龄(34.9±4.2)岁,体质量指数(20.1±2.0) kg/m2。观察指标包括病人一般资料、术中和术后恢复情况。术后门诊随访和B超复查评估疗效。随访截至2022年3月。结果: 脐周区超声检查示腹直肌分离宽度(41.6±8.2) mm。10例合并脐疝,2例合并白线疝。均采用全身麻醉ELAP。疝环予以缝合关闭,手术时间(130.9±36.0) min。术后第1天疼痛视觉模拟评分(1.2±0.6)分;术后住院(1.5±0.9) d。2例术后浆液肿,B超引导下穿刺处理。其余无切口出血、感染等手术并发症发生。47例中位随访15(12,26)个月。1例手术区疼痛不适感,非手术治疗后好转。另1例术前B超检查脐周区分离57.0 mm,术后1个月无分离,3个月显示21.0 mm,为轻度复发。结论:ELAP治疗产伤性腹直肌分离安全、有效。
中图分类号:
何凯, 唐颖, 周秀玲, 朱俞岚, 傅晓键, 朱炎逢, 丁红, 姚琪远, 陈浩. 腔镜腹白线折叠缝合术治疗产伤性腹直肌分离的临床疗效评估[J]. 外科理论与实践, 2023, 28(01): 67-71.
HE Kai, TANG Ying, ZHOU Xiuling, ZHU Yulan, FU Xiaojian, ZHU Yanfeng, DING Hong, YAO Qiyuan, CHEN Hao. Clinical evaluation of endoscopic linea alba plication in treatment of postpartum diastasis recti abdominis muscles[J]. Journal of Surgery Concepts & Practice, 2023, 28(01): 67-71.
[1] |
SPERSTAD J B, TENNFJORD M K, HILDE G, et al. Diastasis recti abdominis during pregnancy and 12 months after childbirth: prevalence, risk factors and report of lumbopelvic pain[J]. Br J Sports Med, 2016, 50(17):1092-1096.
doi: 10.1136/bjsports-2016-096065 URL |
[2] |
RANNEY B. Diastasis recti and umbilical hernia causes, recognition and repair[J]. S D J Med, 1990, 43(10):5-8.
pmid: 2149203 |
[3] |
KESHWANI N, MCLEAN L. Ultrasound imaging in postpartum women with diastasis recti: intrarater between-session reliability[J]. J Orthop Sports Phys Ther, 2015, 45(9):713-718.
doi: 10.2519/jospt.2015.5879 pmid: 26161625 |
[4] |
BITTNER R, BAIN K, BANSAL V K, 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.
doi: 10.1007/s00464-019-06907-7 |
[5] |
REINPOLD W, KÖCKERLING F, BITTNER R, et al. Classification of rectus diastasis—a proposal by the German Hernia Society(DHG) and the International Endohernia Society(IEHS)[J]. Front Surg, 2019, 6:1.
doi: 10.3389/fsurg.2019.00001 URL |
[6] |
KAMEL D M, YOUSIF A M. Neuromuscular electrical stimulation and strength recovery of postnatal diastasis recti abdominis muscles[J]. Ann Rehabil Med, 2017, 41(3):465-474.
doi: 10.5535/arm.2017.41.3.465 pmid: 28758085 |
[7] |
GLUPPE S L, HILDE G, TENNFJORD M K, et al. Effect of a postpartum training program on the prevalence of dia-stasis recti abdominis in postpartum primiparous women: a randomized controlled trial[J]. Phys Ther, 2018, 98(4):260-268.
doi: 10.1093/ptj/pzy008 URL |
[8] |
CARLSTEDT A, BRINGMAN S, EGBERTH M, et al. Management of diastasis of the rectus abdominis muscles: recommendations for Swedish national guidelines[J]. Scand J Surg, 2021, 110(3):452-459.
doi: 10.1177/1457496920961000 URL |
[9] |
ELHAWARY H, ABDELHAMID K, MENG F, et al. A comprehensive, evidence-based literature review of the surgical treatment of rectus diastasis[J]. Plast Reconstr Surg, 2020, 146(5):1151-1164.
doi: 10.1097/PRS.0000000000007252 pmid: 33136963 |
[10] |
MALCHER F, LIMA D L, LIMA R N C L, et al. Endoscopic onlay repair for ventral hernia and rectus abdominis diastasis repair: why so many different names for the same procedure? A qualitative systematic review[J]. Surg Endosc, 2021, 35(10):5414-5421.
doi: 10.1007/s00464-021-08560-5 |
[11] |
NAHAS F X, FERREIRA L M, AUGUSTO S M, et al. Long-term follow-up of correction of rectus diastasis[J]. Plast Reconstr Surg, 2005, 115(6):1736-1741.
doi: 10.1097/01.prs.0000161675.55337.f1 pmid: 15861083 |
[12] |
MOMMERS E H H, PONTEN J E H, AL OMAR A K, et al. The general surgeon′s perspective of rectus diastasis. A systematic review of treatment options[J]. Surg Endosc, 2017, 31(12):4934-4949.
doi: 10.1007/s00464-017-5607-9 URL |
[13] |
KÖCKERLING F, BOTSINIS M D, ROHDE C, et al. Endoscopic-assisted linea alba reconstruction new technique for treatment of symptomatic umbilical, trocar, and/or epigastric hernias with concomitant rectus abdominis diastasis[J]. Eur Surg, 2017, 49(2):71-75.
doi: 10.1007/s10353-017-0473-1 |
[14] | 乐飞, 郝晓辉, 李健文, 等. 腹腔镜辅助腹白线重建术治疗产后腹直肌分离的临床疗效[J]. 中华消化外科杂志, 2018, 17(11):1122-1126. |
YUE F, HAO X H, LI J, et al. Clinical efficacy of laparoscopic-assisted linea alba reconstruction for postpartum diastasis recti[J]. Chin J Dig Surg, 2018, 17(11):1122-1126. | |
[15] |
HE K, ZHOU X, ZHU Y, et al. Muscle elasticity is diffe-rent in individuals with diastasis recti abdominis than healthy volunteers[J]. Insights Imaging, 2021, 12(1):87.
doi: 10.1186/s13244-021-01021-6 |
[16] |
EMANUELSSON P, GUNNARSSON U, DAHLSTRAND U, et al. Operative correction of abdominal rectus diastasis (ARD) reduces pain and improves abdominal wall muscle strength: a randomized, prospective trial comparing retromuscular mesh repair to double-row, self-retaining sutures[J]. Surgery, 2016, 160(5):1367-1375.
doi: 10.1016/j.surg.2016.05.035 URL |
[1] | 廖文强, 李勤裕, 袁建明, 吴卫泽, 王明亮. 免充气腋径路腔镜与传统开放甲状腺手术的疗效对比分析[J]. 外科理论与实践, 2023, 28(01): 83-87. |
[2] | 陈凤超, 侯俊杰. A型肉毒毒素在偏侧面肌痉挛治疗中的临床体会 [J]. 组织工程与重建外科杂志, 2022, 18(6): 498-. |
[3] | 李建锋 李强 黄欢 张希峰 严建锋 蔡莉丹. 高龄患者髋关节置换的ERAS路径与传统路径的临床疗效对比[J]. 组织工程与重建外科杂志, 2022, 18(2): 154-. |
[4] | 庄奥博, 童汉兴, 张勇, 陆维祺, 周宇红, 闾晨涛. 老年原发性腹膜后软组织肉瘤病人手术治疗安全性分析的回顾性队列研究[J]. 外科理论与实践, 2022, 27(06): 534-539. |
[5] | 杨良根, 朱俊强, 胡星辰. 腹腔镜经腹腹膜前疝修补术治疗嵌顿性腹股沟疝[J]. 外科理论与实践, 2022, 27(06): 551-554. |
[6] | 谢妍妍, 吕青, 杜正贵. 乳腺腔镜和机器人手术的现状及未来之路——华西医院经验分享[J]. 外科理论与实践, 2022, 27(05): 396-402. |
[7] | 黄蔚, 李恒宇, 丁晓毅. 晚期乳腺癌介入诊疗的价值及应用[J]. 外科理论与实践, 2022, 27(05): 411-415. |
[8] | 秦伟, 胡延岩, 徐玺谟, 蔡正昊, 李健文, 龚昆梅, 冯波. 中低位直肠癌经肛门与腹腔镜全直肠系膜切除术后近期疗效荟萃分析[J]. 外科理论与实践, 2022, 27(05): 435-442. |
[9] | 王瑞华, 仇鹏, 刘俊超, 吴小雨, 秦金保, 叶开创, 李维敏, 刘晓兵, 殷敏毅, 黄新天, 陆信武. 激光原位开窗胸主动脉腔内重建治疗累及弓部分支的主动脉夹层:近期结果及并发症[J]. 外科理论与实践, 2022, 27(04): 324-329. |
[10] | 聂明明, 朱正纲. 腹腔镜探查对进展期胃癌精准分期的临床意义[J]. 外科理论与实践, 2022, 27(04): 365-370. |
[11] | 郭良奇, 严志龙, 张谋成. 腹腔镜经胃腔手术治疗胃黏膜下肿瘤和早期胃癌[J]. 外科理论与实践, 2022, 27(04): 380-383. |
[12] | 满高亚, 党同科, 吴清松, 冯飞灵. Rouviere沟引导胆囊后隧道解剖用于困难腹腔镜胆囊切除术[J]. 外科理论与实践, 2022, 27(03): 239-243. |
[13] | 杜燕然, 焦景, 任芸芸, 周建桥. 超声影像组学技术在评估胎肺成熟度中的应用[J]. 诊断学理论与实践, 2022, 21(03): 326-330. |
[14] | 王晨琛, 方跃华, 施仲伟, 屈雪蒸. 25例主动脉瓣成形术后一年的超声心动图评价[J]. 诊断学理论与实践, 2022, 21(03): 395-398. |
[15] | 朱鹏, 廖威, 张必翔, 陈孝平. 机器人肝癌肝切除应用现状与前景[J]. 外科理论与实践, 2022, 27(02): 95-99. |
阅读次数 | ||||||
全文 |
|
|||||
摘要 |
|
|||||