外科理论与实践

外科理论与实践››2023,Vol. 28››Issue (01): 67-71.doi:10.16139/j.1007-9610.2023.01.11

• 论著 •上一篇下一篇

腔镜腹白线折叠缝合术治疗产伤性腹直肌分离的临床疗效评估

何凯a, 唐颖b,*, 周秀玲c, 朱俞岚d, 傅晓键a, 朱炎逢b, 丁红c, 姚琪远a, 陈浩a()

  1. a.复旦大学附属华山医院 普外科，上海 200040
    b.复旦大学附属华山医院 手术室，上海 200040
    c.复旦大学附属华山医院 超声影像科，上海 200040
    d.复旦大学附属华山医院 康复医学科，上海 200040
  • 收稿日期:2022-05-24出版日期:2023-01-25发布日期:2023-03-25
  • 通讯作者:唐颖,陈浩 E-mail:fzjfl2019@163.com
  • 基金资助:
    上海市科学技术委员会生物医药科技支撑项目(20S31904900)

Clinical evaluation of endoscopic linea alba plication in treatment of postpartum diastasis recti abdominis muscles

HE Kaia, TANG Yingb,*, ZHOU Xiulingc, ZHU Yuland, FU Xiaojiana, ZHU Yanfengb, DING Hongc, YAO Qiyuana, CHEN Haoa()

  1. a. Department of General Surgery, Huashan Hospital, Fudan University, Shanghai 200040, China
    b. Department of Operative Room, Huashan Hospital, Fudan University, Shanghai 200040, China
    c. Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai 200040, China
    d. Department of Rehabilitation, Huashan Hospital, Fudan University, Shanghai 200040, China
  • Received:2022-05-24Online:2023-01-25Published:2023-03-25
  • Contact:TANG Ying,CHEN Hao E-mail:fzjfl2019@163.com

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摘要：

目的：回顾性研究腔镜腹白线折叠缝合术（endoscopic linea alba plication, ELAP）治疗产伤性腹直肌分离的临床疗效。方法：收集本院2018年1月至2021年12月采用ELAP治疗产伤性腹直肌分离病人的临床资料。共48例病人实施ELAP手术，1例失访，47例纳入研究。病人年龄（34.9±4.2）岁，体质量指数（20.1±2.0） kg/m2。观察指标包括病人一般资料、术中和术后恢复情况。术后门诊随访和B超复查评估疗效。随访截至2022年3月。结果：脐周区超声检查示腹直肌分离宽度（41.6±8.2） mm。10例合并脐疝，2例合并白线疝。均采用全身麻醉ELAP。疝环予以缝合关闭，手术时间（130.9±36.0） min。术后第1天疼痛视觉模拟评分（1.2±0.6）分；术后住院（1.5±0.9） d。2例术后浆液肿，B超引导下穿刺处理。其余无切口出血、感染等手术并发症发生。47例中位随访15（12，26）个月。1例手术区疼痛不适感，非手术治疗后好转。另1例术前B超检查脐周区分离57.0 mm，术后1个月无分离，3个月显示21.0 mm，为轻度复发。结论：ELAP治疗产伤性腹直肌分离安全、有效。

关键词:产伤性腹直肌分离,腹壁重建,腔镜,并发症,复发

Abstract:

ObjectiveTo conduct a retrospective study on the clinical efficacy with endoscopic linea alba plication (ELAP) in the treatment of postpartum diastasis recti abdominis muscles.MethodsClinical data was collected to study the patients with postpartum diastasis recti abdominis muscles treated by ELAP in our hospital from January 2018 to December 2021. The operation was performed successfully in 48 cases. One case was lost follow-up and 47 cases were included in this study. Mean age was (34.9±4.2) years with body mass index (BMI) (20.1±2.0) kg/m2. The index of patients included general data, intraoperative data and postoperative recovery. Follow-up was done through out-patient examination and B-mode ultrasonography until to March 2022.ResultsThe inter-rectus distance (IRD) in umbilical area (M3) shown by ultrasound examination was (41.6±8.2) mm. There were 10 cases combined with umbilical hernia and 2 cases with linea alba hernia. ELAP was performed under general anesthesia. All hernia rings were closed by suturing. The operative time was (130.9±36.0) min. Visual analog scale was (1.2±0.6) on the 1st postoperative day with postoperative hospital stay (1.5±0.9) d. Two cases had mild seroma postoperatively with puncture and absorption under B-ultrasound guiding. Remaining cases were without operative complications such as bleeding and infection of incision. Followed up of 47 cases was completed in the period of median 15(12, 26) months. One case had mild pain in the operative site and cured after non-operative treatment. Ultrasound examination in the other case showed 57.0 mm of IRD in M3 area preoperative and normal in the follow-up of 1 month postoperative. However, there was mild recurrence on 3 months of follow-up showing IRD 21.0 mm.ConclusionsELAP could be considered safe and effective in the treatment of postpartum diastasis recti abdominis muscle.

Key words:Postpartum diastasis recti abdominis muscle,Abdominal wall reconstruction,Endoscopy,Complication,Recurrence

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