目的 分析开放式补片修补术治疗腹壁切口疝的临床疗效。方法 回顾性分析我院于2013年10月至2018年3月行开放式补片修补术的210例腹壁切口疝病人的临床资料。分析不同术式和补片固定方式,术后血清肿、切口感染、补片感染、慢性疼痛、肠漏、复发以及死亡的发生。结果 术后血清肿25例（11.90%）,切口感染14例（6.67%）,补片感染3例（1.43%）,慢性疼痛7例（3.33%）,肠漏3例（1.43%）,复发7例（3.33%）,死亡2例（0.95%）。采用IPOM术式病人术后仅有血清肿并发症发生率低于Sublay术（P<0.05）,差异有统计学意义,其余并发症发生和复发率差异无统计学意义（P>0.05）。Sublay术式中加强法与桥接法术后并发症差异无统计学意义（P>0.05）。采用缝线+不可吸收疝钉组与缝线+可吸收疝钉组术后慢性疼痛和复发率无统计学差异（P>0.05）。结论 开放式补片修补术治疗腹壁切口疝安全有效。
Objective To analyze the clinical outcome of open mesh repair in treating ventral incisional hernia. Methods A retrospective analysis was performed for 210 patients with ventral incision hernia who had open mesh repaired from October 2013 to March 2018 in this hospital. The postoperative complications including seroma, incision infection, mesh infection, chronic pain, intestinal fistula, hernia recurrence and mortality were evaluated between 2 repairs [intraperitoneal onlay mesh (IPOM) and sublay] and between 2 mesh fix methods. Results After operation, there were 25 cases (11.90%) of seroma, 14 cases (6.67%) of incision infection, 3 cases (1.43%) of mesh infection, 7 cases (3.33%) of chronic pain, 3 cases (1.43%) of intestinal fistula, 7 cases (3.33%) of recurrence and 2 cases(0.95%) of death. The patients with postoperative seroma using IPOM repair were lower than those using Sublay repair(P<0.05) with significant difference. There was no significant difference in other complications and hernia recurrence rate between 2 repairs (P>0.05). There was no statistically significant difference in complications between the patients using reinforcement and bridging after Sublay repair (P>0.05). The case with chronic pain and recurrence rates had no statistically significant difference (P>0.05) using non-absorbable hernia nail when compared those using absorbable hernia nail. Conclusions Open ventral incisional hernia mesh repair is considered as safe and effective.
[1] 腹壁切口疝诊疗指南(2014年版)[J]. 中国实用外科杂志,2014,34(6):487-489.
[2] Itatsu K, Sugawara G, Kaneoka Y, et al.Risk factors for incisional surgical site infections in elective surgery for colorectal cancer: Focus on intraoperative meticulous wound management[J]. Surgery Today,2014(7):1242-1252.
[3] Anthony T, Bergen PC, Kim LT, et al.Factors affecting recurrence following incisional herniorrhaphy[J]. World J Surg,2000,24(1):95-101.
[4] Burger JW, Luijendijk RW, Hop WC, et al.Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia[J]. Ann Surg,2004,240(4):578-585.
[5] Memon AA, Khan A, Zafar H, et al.Repair of large and giant incisional hernia with onlay mesh: perspective of a tertiary care hospital of a developing country[J]. Int J Surg,2013,11(1):41-45.
[6] 王明刚, 刘雨辰, 曹金鑫. 手术治疗腹壁切口疝的历史与现状[J]. 腹腔镜外科杂志,2017,22(2):81-85.
[7] Oravsky M, Bak V, Petrovajova T, et al.Laparoscopic repair of incisional hernias - our first experience[J]. Rozhl Chir,2013,92(2):91-94.
[8] Silecchia G, Campanile FC, Sanchez L, et al.Laparoscopic ventral/incisional hernia repair: updated Consensus Development Conference based guidelines [corrected][J]. Surg Endosc,2015,29(9):2463-2484.
[9] Berrevoet F, Vanlander A, Sainz-Barriga M, et al.Infec-ted large pore meshes may be salvaged by topical negative pressure therapy[J]. Hernia, 2013,17(1):67-73.
[10] Deerenberg EB, Timmermans L, Hogerzeil DP, et al.A systematic review of the surgical treatment of large incisional hernia[J]. Hernia,2015,19(1):89-101.
[11] LeBlanc KA, Whitaker JM, Bellanger DE, et al. Laparoscopic incisional and ventral hernioplasty: lessons learned from 200 patients[J]. Hernia,2003,7(3):118-124.
[12] Sauerland S, Walgenbach M, Habermalz B, et al. Laparo-scopic versus open surgical techniques for ventral or incisional hernia repair[J]. Cochrane Database Syst Rev, 2011,(3):CD007781.
[13] Cavallaro G, Campanile FC, Rizzello M, et al.Lightweight polypropylene mesh fixation in laparoscopic incisional hernia repair[J]. Minim Invasive Ther Allied Technol,2013,22(5):283-287.
