Department of Urology, University of California, Irvine, School of Medicine, Orange, California 92868, USA.
Urology. 2011 Sep;78(3):586-90. doi: 10.1016/j.urology.2011.03.067. Epub 2011 Jul 8.
To examine the incidence of incisional hernias (IHs) and propose a simple modification to reduce the incidence of IHs. Robot-assisted radical prostatectomy (RARP) historically uses a vertical midline camera port incision to extract the prostate.
Of 900 consecutive RARPs, the initial 735 had a vertical and subsequent 165 transverse incisions. Two methods were used to identify IHs: clinic visits noted in the prospective database and screening using electronic mail. We compared the baseline factors between the vertical IH and IH-free cohorts. The maximal scar width was recorded in 178 consecutive men presenting to our clinic: vertical (n=107) and transverse (n=71).
IHs occurred significantly more often after a vertical incision (5.3% vs 0.6%, P=.005). The IH rates after a vertical incision could be estimated to be as great as 16.7% (18 of 108) using the electronic mail respondents or as low as 3.3% (21 of 627) according to clinic follow-up. On univariate analysis, baseline age, International Index of Erectile Function 5-item questionnaire, prostate weight, bother score (all P≤.05), and body mass index (P=.058) were associated with an increased risk of an IH. After adjusting for baseline factors on multivariate logistic regression analysis, the relative odds of developing an IH with a vertical versus transverse incision was 11 (95% confidence interval 1.5-82). The average maximal scar width was reduced from 5.5 to 2.0 mm (P<.0001).
In the present sample population, the vertical IH rate was estimated to be potentially as low as 3.3% or as great as 16.7%. On multivariate analysis, a greater body mass index and larger prostate size significantly increased the risk of hernia development. Transverse incisions dramatically reduced the rate of IHs and the maximal scar width. The IH rates varied significantly by reporting method.
探讨切口疝（IHs）的发生率，并提出一种简单的改良方法以降低 IH 的发生率。机器人辅助根治性前列腺切除术（RARP）历史上采用垂直中线摄像端口切口提取前列腺。
在 900 例连续的 RARPs 中，最初的 735 例为垂直切口，随后的 165 例为横切口。使用两种方法来识别 IH：前瞻性数据库中的临床就诊记录和电子邮件筛查。我们比较了垂直 IH 和无 IH 队列之间的基线因素。在我们的诊所就诊的 178 例连续男性中记录了最大疤痕宽度：垂直（n=107）和横切（n=71）。
垂直切口后 IH 的发生率显著更高（5.3% vs 0.6%，P=.005）。使用电子邮件回复者估计，垂直切口后 IH 的发生率高达 16.7%（18/108），而根据临床随访，发生率低至 3.3%（21/627）。单因素分析显示，基线年龄、国际勃起功能指数 5 项问卷、前列腺重量、困扰评分（均 P≤.05）和体重指数（P=.058）与 IH 风险增加相关。在多变量逻辑回归分析中，根据基线因素调整后，垂直与横切切口发生 IH 的相对风险比为 11（95%置信区间 1.5-82）。最大疤痕宽度平均从 5.5 降至 2.0 毫米（P<.0001）。
在本样本人群中，垂直 IH 的发生率估计低至 3.3%，高至 16.7%。多变量分析显示，更大的体重指数和更大的前列腺体积显著增加了疝发生的风险。横切口显著降低了 IH 的发生率和最大疤痕宽度。IH 的发生率因报告方法而异。
