摘要
目的探讨全腔镜下肌后/腹膜外补片修补术(TES)在产后腹直肌分离手术治疗的应用价值,分析其技术细节,可行性及有效性。方法前瞻性收集2020年1月至2023年1月南方医科大学附属何贤纪念医院收治的产后腹直肌分离症患者的相关资料,所有患者均实行TES手术,手术相关资料以及随访结果均被记录分析。结果本研究共完成25例患者,平均年龄36岁。所有手术均顺利完成,本组腹直肌最宽处缺损横径3~9 cm,平均(5.6±1.5)cm;手术时间95~173 min,平均(121.3±15.6)min;术中出血极少(<5 ml);使用补片长径18~25cm,平均(22.7±2.6)cm,横径13~18 cm,平均(15.5±2.1)cm。术后伤口疼痛轻微,术后第1天静息状态疼痛视觉模拟评分1~4分,平均(2.2±0.4)分,术后住院时间3~8 d,平均5.5 d,无补片感染病例。23例患者(92.0%)得到随访,平均随访周期12.3个月,无慢性疼痛发生,无复发患者。结论TES技术治疗产后腹直肌分离安全可行,无需使用防粘连补片,无需使用钉枪等有创固定,在明显减少腹腔内补片相关并发症同时,大大减少术后疼痛,另外也明显节省医疗费用。
Objective Investigating a minimally invasive sublay mesh repair approach(Totally endoscopic sublay,TES)for postpartum rectus diastasis,describing its technical details,and evaluating the feasibility and efficacy.Methods We prospectively collected the demographics of postpartum rectus diastasis cases who were admitted to Affiliated Hexian Memorial Hospital of Southern Medical University from January 2020 to January 2023.All of these cases were operated with TES procedure.Results A consecutive series of 25 patients with a mean age of 36 year were included.All operations were successful without conversion.The average widest transverse defect of the rectus diastasis was 5.6±1.5 cm(range 3-9 cm),the mean operative time was 121.3±15.6 min(range95-173 min),the average length of mesh implanted was 22.7±2.6 cm(range18-25 cm),and the width was 15.5±2.1 cm(range13-18 cm).Postoperative pain was mild,with a mean VAS score of 2.2±0.4 at day 1.The average length of hospital stay was 5.5 days.No mesh infection was detected,and no chronic pain or hernia recurrence was noted in a mean follow-up period of 12.3 months.Conclusion The TES operation for the treatment of postpartum rectus diastasis is safe and feasible.Anti-adhesive coated meshes and fixation tackers are not required,making this a cost-effective procedure that is worthy of recommendation.
作者
李炳根
龚独辉
赖泽如
聂向阳
Li Binggen;Gong Duhui;Lai Zeru;Nie Xiangyang(Hepatobiliary and Hernia Surgery Department Affiliated Hexian Memorial Hospital of Southern Medical University,Guangzhou 511400,China)
出处
《中华疝和腹壁外科杂志（电子版）》
2023年第6期724-727,共4页
Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition)
基金
吴阶平医学基金会临床科研专项资助基金(320.6750.18393)
作者简介
通信作者:李炳根,Email:Binggen_li@outlook.com
