Department of Surgery, Medisch Centrum Alkmaar, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands.
Hernia. 2010 Jun;14(3):237-42. doi: 10.1007/s10029-009-0619-6. Epub 2010 Jan 9.
An incisional hernia is a frequent complication of abdominal surgery. The repair of incisional hernias comes with a high risk of reherniation and serious complications. With the introduction of mesh repair, recurrence rates have decreased and subsequent clinical outcomes have improved. Whereas further research needs to be done to improve complication rates and recurrence, the focus has now been placed on quality-of-life outcomes in patients undergoing these repairs. The aim of this study was to investigate the long-term health-related quality of life (HRQL) of patients who were treated for incisional hernias using an onlay technique.
Over a period of 10 years (1997-2007), 101 patients with an incisional hernia were treated with an onlay marlex mesh, fixed on the fascia with skin staples. Of the 101 patients, there were 45 males and 56 females, and their mean age was 55 years. Nine patients died and 13 were lost during follow-up. Of the remaining 79 patients, eight refused to participate. The mean follow-up time was 64 months (normal distribution, standard deviation [SD] 35 months). The Short Form 36 (SF-36) and the Karnofsky Performance Status Scale (KPS) and a semi-structured interview were used to measure HRQL.
Seventy-one of the 101 patients were evaluated at our out-patient clinic. Twenty-one patients (20%) had an open-abdomen treatment in their medical history. The median admission time was 4.5 days (quartiles 3-6.25). The mean follow-up time was 64 months (SD 35 months). A seroma was reported in 27 of the 101 patients (27%) and a wound infection in 22 patients (21%), of which five patients had to be re-operated. Only if a patient was evaluated at our out-patient clinic could reherniation be scored; this occurred in 11 of 71 patients (16%). The evaluation of HRQL showed equal SF-36 scores for patients treated for an incisional hernia compared to their matched controls. Patients with a history of an open-abdominal treatment did not score significantly lower compared to patients without such a treatment. The median KPS score was 75, indicating that activities could be performed with effort and patients had some signs of disease.
HRQL is the same in patients treated for an incisional hernia compared to the matched controls. Therefore, the onlay technique seems to be an acceptable method to repair large incisional hernias.
切口疝是腹部手术后的常见并发症。切口疝的修补存在很高的复发和严重并发症风险。随着网片修补的引入，复发率已经降低，随后的临床结果得到改善。虽然需要进一步研究来降低并发症发生率和复发率，但现在的重点已放在接受这些修复的患者的生活质量结果上。本研究旨在探讨采用嵌片技术治疗切口疝患者的长期健康相关生活质量（HRQL）。
在 10 年期间（1997-2007 年），采用 Marlex 网片行嵌片修补术治疗 101 例切口疝患者，网片固定于筋膜上并用皮肤钉固定。101 例患者中，男 45 例，女 56 例，平均年龄 55 岁。9 例死亡，13 例随访丢失。其余 79 例患者中有 8 例拒绝参与。平均随访时间为 64 个月（正态分布，标准差[SD]为 35 个月）。采用简明 36 项健康调查量表（SF-36）、卡诺夫斯基绩效状态量表（KPS）和半结构式访谈来测量 HRQL。
101 例患者中有 71 例在我院门诊接受评估。21 例（20%）患者有腹部开放治疗史。中位住院时间为 4.5 天（四分位间距 3-6.25）。平均随访时间为 64 个月（SD 35 个月）。101 例患者中有 27 例（27%）报告有血清肿，22 例（21%）有伤口感染，其中 5 例需要再次手术。只有在我院门诊接受评估的患者才能对复发进行评分；71 例患者中有 11 例（16%）发生复发。HRQL 评估显示，接受切口疝治疗的患者的 SF-36 评分与匹配对照组相同。有腹部开放治疗史的患者与无此类治疗史的患者相比，评分并无显著降低。中位 KPS 评分为 75，表明患者可以努力进行活动，并且存在一些疾病迹象。
与匹配对照组相比，接受切口疝治疗的患者的 HRQL 相同。因此，嵌片技术似乎是修复大型切口疝的一种可接受方法。
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