本文選題：切口疝 + 疝修補術　； 參考：《浙江大學》2017年碩士論文

【摘要】：背景腹壁切口疝是腹部外科術后常見的長期并發(fā)癥之一,發(fā)生率在11-20%,切口疝一旦形成,保守治療難以治愈,進展后還可能導致腸粘連及腸絞窄,甚至危及生命,手術治療是唯一的有效手段。開放式修補是傳統(tǒng)的手術方式,隨著腹腔鏡手術及修補材料的不斷發(fā)展,腹腔鏡切口疝修補術應用越來越普遍,近年一些專家還將腹腔鏡技術與開放術式相結合,形成雜交技術(Hybrid Technique incisional hernia repair),大宗文獻報道比較了各種術式的療效,但結果差異性很大,哪種術式是才是最理想的手術方式目前仍存在爭議。目的對比分析開放術式、雜交術式、腹腔鏡術式三種手術方式治療腹壁切口疝的臨床療效,為外科醫(yī)生選擇最理想的術式提供參考。方法回顧性分析浙江大學醫(yī)學院附屬邵逸夫醫(yī)院2010年1月至2016年6月行腹壁切口疝修補術的86例患者的臨床資料,其中OIHR組(開放組)28例,HTIHR組(雜交組)27例,LIHR組(腹腔鏡組)31例,在排除年齡、性別、BMI、ASA分級、合并癥等一般資料的差異性之后,對比三組術中術后的一些臨床指標有無統(tǒng)計學意義,其中計量資料包括手術時間、術中出血、腹壁缺損大小、術后恢復進食時間、術后使用鎮(zhèn)痛藥次數(shù)、住院時間等,計數(shù)資料包括血清腫/漿液腫,切口感染,肺部感染,腹壁疼痛等相關并發(fā)癥及復發(fā)情況。結果三組患者在一般資料、切口疝類型、術中出血、住院時間、并發(fā)癥上無顯著性差異。LIHR組較其他兩組腹壁缺損面積小(P0.05),術后進食時間(即腸道恢復時間)短(P0.05),使用鎮(zhèn)痛藥次數(shù)少(P0.05),有統(tǒng)計學意義。較OIHR組手術時間短,但差異不顯著。HTIHR組較LIHR組手術時間長(P0.05),有明顯統(tǒng)計學差異。OIHR組復發(fā)率21.4%(6/28),LIHR組復發(fā)率3.2%(1/31),HTIHR組無復發(fā)病例,有顯著統(tǒng)計學差異。結論腹腔鏡腹壁切口疝修補術與雜交技術切口疝修補術均是安全有效的可替代傳統(tǒng)開放術式的手術方式,腹腔鏡術式較開放術式有損傷小、手術時間短、疼痛少、恢復快等優(yōu)勢。而對于較復雜較大的切口疝及復發(fā)疝,雜交技術將開放術式直視分離與腹腔鏡術式直視固定補片的優(yōu)勢結合起來,從而提高了手術療效、降低復發(fā)率。另外隨著修補材料、固定材料、手術方式尤其是機器人手術、術后評估等技術的不斷發(fā)展,腹腔切口疝的手術治療將會取得越來越好的效果。
[Abstract]:Background incisional hernia of abdominal wall is one of the common long-term complications after abdominal surgery. The incidence of incisional hernia is 11-20. Once incisional hernia is formed, conservative treatment is difficult to cure. Surgical treatment is the only effective means. Open repair is a traditional surgical method. With the development of laparoscopic surgery and repair materials, laparoscopic incisional hernioplasty is becoming more and more common. In recent years, some experts have combined laparoscopic technique with open operation. Hybrid Technique incisional hernia repairn (hybrid Technique incisional hernia repairn) was formed. A large number of literature reports have compared the efficacy of various surgical procedures, but the results are very different, which is the most ideal operation method is still controversial. Objective to compare and analyze the clinical effects of open operation, hybrid operation and laparoscopic operation in the treatment of abdominal incisional hernia, and to provide a reference for surgeons to choose the most ideal operation. Methods the clinical data of 86 patients undergoing incisional herniorrhaphy of abdominal wall from January 2010 to June 2016 in run run run Shaw Hospital affiliated to Zhejiang University Medical College were retrospectively analyzed. Among them, OIHR group (open group, 28 cases with HTIHR) (hybridization group, 27 cases), LIHR group (LIHR group, 31 cases), after ruling out the difference of age, sex, BMIASA grade, complication and other general data, etc. There were significant differences in some clinical indexes between the three groups, including operative time, intraoperative bleeding, abdominal wall defect, postoperative recovery time, times of using analgesics after operation, hospitalization time and so on. Counting data included seroderma / seroderma, incision infection, pulmonary infection, abdominal wall pain and other related complications and recurrence. Results three groups of patients in general information, incisional hernia type, intraoperative bleeding, hospital stay, There was no significant difference in complications. The area of abdominal wall defect in the LIHR group was smaller than that in the other two groups. The feeding time (that is intestinal recovery time) after operation was shorter than that in the other two groups (P 0.05), and the number of times of using analgesics was less than that of the other two groups (P 0.05). The time of operation was shorter than that of OIHR group, but the difference was not significant. The operation time of HTIHR group was longer than that of LIHR group (P 0.05), there was significant difference. The recurrence rate of OIHR group was 21. 4% / 28% LIHR group, the recurrence rate was 3. 2% / 31% HTIHR group and there were no recurrence cases, there was significant statistical difference. Conclusion Laparoscopic incisional herniorrhaphy and hybrid herniorrhaphy are safe and effective alternative to traditional open hernia repair. Laparoscopy has less injury, shorter operation time and less pain than open operation. Recover advantages such as speed. For the more complex and larger incisional hernia and recurrent hernia, the hybrid technique combined the advantages of open open surgery with laparoscopic direct vision fixed patch to improve the curative effect and reduce the recurrence rate. In addition, with the development of repair materials, fixation materials, surgical methods, especially robotic surgery, postoperative evaluation and other technologies, surgical treatment of abdominal incisional hernia will achieve more and more good results.
【學位授予單位】：浙江大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R656.2

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