腹腔镜与开放式腹腔内补片修补术治疗切口疝的长期疗效：倾向评分匹配分析。
Long-term results of laparoscopic versus open intraperitoneal onlay mesh incisional hernia repair: a propensity score-matched analysis.
机构信息
Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland.
出版信息
Surg Endosc. 2019 Jan;33(1):225-233. doi: 10.1007/s00464-018-6298-6. Epub 2018 Jun 25.
BACKGROUND
Intraperitoneal onlay mesh repair (IPOM) of incisional hernia is performed by laparoscopic and open access. The aim of the present study is to compare open versus laparoscopic surgery specifically using an IPOM technique for incisional hernia repair.
METHODS
A propensity score-matched observational single center study of patients that underwent IPOM between 2004 and 2015 was conducted. The primary outcome was hernia recurrence; secondary outcomes include length of stay, surgical site infections (SSI), complications, and localization of recurrence.
RESULTS
Among 553 patients with incisional hernia repair, 59% underwent laparoscopic and 41% open IPOM. A total of 184 patients completed follow-up. After a mean follow-up of 5.5 years recurrence rate was 20% in laparoscopic and 19% in open repair (p = 1.000). Patients undergoing laparoscopic IPOM had significantly reduced operation time (median 120 vs. 180 min, p < 0.001), shorter hospital stays (6 vs. 8 days, p = 0.002), less complications (10 vs. 23%, p = 0.046), and fewer SSI (1 vs. 21%, p < 0.001).
CONCLUSIONS
Laparoscopic IPOM is associated with reduced morbidity compared to open IPOM for incisional hernia repair.
背景
腹腔内补片修补术（IPOM）是通过腹腔镜和开放两种方式进行切口疝修补。本研究的目的是比较开放与腹腔镜手术，特别是使用 IPOM 技术进行切口疝修补。
方法
对 2004 年至 2015 年间接受 IPOM 的患者进行了倾向评分匹配的观察性单中心研究。主要结局是疝复发；次要结局包括住院时间、手术部位感染（SSI）、并发症和复发定位。
结果
在 553 例切口疝修补患者中，59%接受了腹腔镜和 41%的开放 IPOM。共有 184 例患者完成了随访。平均随访 5.5 年后，腹腔镜组和开放组的复发率分别为 20%和 19%（p=1.000）。接受腹腔镜 IPOM 的患者手术时间明显缩短（中位数 120 分钟 vs. 180 分钟，p<0.001），住院时间缩短（6 天 vs. 8 天，p=0.002），并发症减少（10% vs. 23%，p=0.046），SSI 减少（1% vs. 21%，p<0.001）。
结论
与开放 IPOM 相比，腹腔镜 IPOM 可降低切口疝修补的发病率。
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