产后腹直肌分离手术治疗的初步评估

doi:10.16139/j.1007-9610.2024.04.10

摘要/Abstract

摘要：

目的：初步评价产后腹直肌分离(PDR)手术的临床疗效、安全性及术后功能改善情况。方法：回顾性研究2018年11月至2023年10月在同济大学附属东方医院疝与腹壁外科行手术治疗的PDR病人，对其基本资料、手术情况、术后并发症、复发以及手术前后功能评价结果等分析与评价。结果：共纳入39例，其中开放手术21例，腹腔镜手术17例，杂交手术1例。单纯白线重建（LAR）3例；在LAR基础上行肌后（Sublay）网片修补26例，肌前（Onlay）修补9例，腹腔内（IPOM）修补1例。随访6~45个月，完成率92.3%。随访期间无复发病例，总体并发症发生率20.5%，其中1例伤口愈合延迟，2例血清肿，5例脐旁与脐下皮肤感觉障碍。欧洲疝学会腹壁疝登记系统生活质量（EuraHS QoL）评分与评价腰背痛的Oswestry功能障碍指数（ODI）术后有显著改善。腹腔镜手术病人的分离程度小于开放手术病人（腹直肌间距中位数4.0 cm 比4.5 cm），腹腔镜手术病人的住院天数较开放手术病人更短（中位数7 d比9 d）。结论：PDR的手术治疗总体安全、有效，除纠正分离，还改善病人的生活质量和腰背痛。应对不同情况的病人选择个体化的手术方案。

关键词: 产后腹直肌分离, 白线重建术, 肌后修补, 肌前修补, 生活质量

Abstract:

Objective To evaluate the clinical efficacy, safety and the postoperative functional improvement of the surgical treatment for postpartum diastasis recti (PDR). Methods A retrospective study was conducted on the patients with PDR who underwent surgical treatment in Department of Hernia and Abdominal Wall Surgery, Shanghai East Hospital, Tongji University from November 2018 to October 2023. The patients’demography, operation data, postoperative complications, recurrence and functional evaluation before and after surgery were analyzed. Results A total of 39 cases were included. Open surgery was performed in 21 cases, laparoscopic surgery in 17 cases, and hybrid surgery in 1 case. On the basis of linear alba reconstruction (LAR), 26 cases were additionally repaired with Sublay mesh, 9 with Onlay, and 1 with intraperitoneal onlay mesh (IPOM); the other 3 cases were only performed with LAR. The follow-up ranged 6-45 months, and the completion rate was 92.3%. During the follow-up, no recurrence was observed, and the overall complication rate was 20.5%, including 1 case with delayed wound healing, 2 cases with seroma, and 5 cases with skin disorders in paraumbilical and subumbilical area. There were significant changes of European Registry for abdominal wall hernias quality of life (EuraHS QoL) score and Oswestry disability index (ODI) after operation, indicating significant improvement in QoL and lower back pain. The inter-recti distance(IRD) of the patients undergoing laparoscopic surgery was less than that of the patients undergoing open surgery (median 4.0 cm vs. 4.5 cm), and the duration of hospital stay of the patients undergoing laparoscopic surgery was shorter than that of open surgery (median 7 days vs. 9 days). Conclusions In general, the surgical treatment of PDR is safe and effective, and it can not only correct the separation, but also improve QoL and lower back pain of the patients. Tailored surgical procedures should be selected for patients with different conditions.

Key words: Postpartum diastasis recti(PDR), Linear alba reconstruction(LAR), Sublay repair, Onlay repair, Quality of life (QoL)

中图分类号:

R656.3
R714

刘璐, 朱晓强, 柳楠, 刘嘉杰, 汤睿. 产后腹直肌分离手术治疗的初步评估[J]. 外科理论与实践, 2024, 29(04): 329-335.

LIU Lu, ZHU Xiaoqiang, LIU Nan, LIU Jiajie, TANG Rui. Preliminary evaluation of surgical treatment for postpartum diastasis recti[J]. Journal of Surgery Concepts & Practice, 2024, 29(04): 329-335.

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参考文献 16

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Item	Preoperative	Postoperative	Z value	P value
EuraHS QoL score	20(18-27.75)	12(8-22)	-3.529	<0.05
Pain of the side of the hernia	1(0-5)	0	-3.526	<0.01
Restrictions of activities because of pain or discomfort	2(0-16)	1(0-11)	-0.696	0.486
Cosmetic discomfort	16(10-20)	7.5(4-10)	-4.603	<0.01
ODI	7(1-12.75)	3(0-6.75)	-3.116	<0.05

Item	Lap（n=17）	Open（n=21）	t/Z value	P value
BMI (kg/m²)	21.2±2.9	21.4±2.1	-0.244	0.809
Age (years)	37（32-38）	36.00（32-40）	-0.162	0.871
Operative time (min)	251±98	226±44	0.942	0.357
IRD (cm)	4.0（4.0-4.8）	4.5（4.3-6.5）	-1.985	0.047
24 h VAS	4（2-6）	3（3-5）	-0.225	0.822
48 h VAS	3（1-5）	3（1-4）	-0.665	0.506
Hospital stays (days)	7（7-8）	9（7-10）	-1.975	0.048
Cost (RMB)	39 232（37 215-42 556）	35 385（31 698-47 269）	-1.659	0.097

Item	Lap Sublay（n=11）	Open Sublay（n=15）	t/Z value	P value
BMI (kg/m²)	21.7±2.8	20.8±2.2	0.916	0.369
Age (years)	36.6±5.2	36.1±6.4	-0.223	0.826
IRD (cm)	4.0（4.0-4.5）	4.5（4.5-7.0）	-2.026	0.043
Operative time (min)	280 (210-330)	220 (200-290)	-1.355	0.176
24 h VAS	3（2-4）	3（3-4）	-0.334	0.739
48 h VAS	3（1-3）	2（1-3）	-0.876	0.381
Hospital stays (days)	7（7-10）	9（7-10）	-1.413	0.158
Cost (RMB)	39 462（39 090-42 642）	35 709（33 584-47 253）	-1.583	0.113