Umbilical hernia in adults
Umbilical hernia in adults
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成人脐疝
DOI：
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发表时间：
2003
期刊：
影响因子：
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通讯作者：
N. Patil
中科院分区：
文献类型：
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作者：
H. Lau;N. Patil
背景：对于成人脐疝的最佳修复技术尚无共识。腹腔镜疝成形术在脐疝中的作用仍有争议。本研究的目的是比较开放式和腹腔镜下脐疝修补术的效果。方法：1996年1月至2002年12月对102例脐疝患者行选择性修补术。手术技术包括Mayo修补术（n = 43）、腹腔镜下Gore-Tex补片疝修补术（n = 26）、缝合疝修补术（n = 24）和补片疝修补术（n = 9）。结果：四组患者的人口学特征和危险因素相似。腹腔镜疝修补术的手术时间（中位数，66 min）明显长于Mayo修补术（60 min）或缝合疝修补术（50 min） （p < 0.05）。接受腹腔镜补片修补术的患者没有一例需要转开修补术。术后第1天休息时的中位疼痛评分，行腹腔镜修复的患者明显低于行Mayo修复的患者。接受腹腔镜修复的患者住院时间明显缩短，伤口发病率也较低。在平均2年的随访中，缝合疝修补术的复发率相对较高（8.7%），而其他技术无复发记录。结论：腹腔镜下补片疝修补术是一种安全、有效的脐疝修补技术。与梅奥修复相比，腹腔镜方法具有减少术后疼痛、缩短住院时间和降低发病率的优点。
Background: There is no consensus on the best technique for the repair of umbilical hernia in adults. The role of laparoscopic hernioplasty of umbilical hernia remains controversial. This study was undertaken to compare the outcomes of open and laparoscopic onlay patch repair of umbilical hernia in adults. Methods: From January 1996 to December 2002, 102 patients underwent elective repair of umbilical hernia. Operative techniques included Mayo repair (n = 43), laparoscopic onlay Gore-Tex patch hernioplasty (n = 26), suture herniorrhaphy (n = 24), and mesh hernioplasty (n = 9). Results: Demographic features and risk factors were similar among the four groups. The operative time of laparoscopic hernioplasty (median, 66 min) was significantly longer than those for patients who underwent Mayo repair (60 min) or sutured herniorrhaphy (50 min) (p < 0.05). None of the patients who underwent laparoscopic patch repairs required conversion to open repair. The median pain score at rest on postoperative day 1 was significantly lower in patients who underwent laparoscopic repair compared to those who had Mayo repair. A significantly shorter hospital stay and a lower wound morbidity rate were also observed in patients who underwent laparoscopic repair. With a mean follow-up of 2 years, suture herniorrhaphy had a relatively high recurrence rate (8.7%), whereas no recurrence was documented for the other techniques. Conclusions: Laparoscopic onlay patch hernioplasty is a safe and efficacious technique for the repair of umbilical hernia. Compared to Mayo repair, the laparoscopic approach confers the advantages of reduced postoperative pain, shorter hospital stay, and a diminished morbidity rate.