完全腹膜外修补术治疗切口疝临床效果观察
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摘要
目的观察腹腔镜下完全腹膜外修补术治疗切口疝的临床效果。方法选取北部战区总医院自2016年2月至2017年2月收治的25例切口疝患者为研究对象,其中,上腹部切口疝患者9例,下腹部切口疝患者16例。所有患者均接受腹腔镜下完全腹膜外修补术治疗。记录患者围术期相关指标,以及随访期间不良反应发生情况。结果所有患者手术均顺利完成。上腹部切口疝患者手术时间为190(90～290)min,术后住院时间为4.1(1.0～7.0)d;下腹部切口疝患者手术时间为157(60～245)min,术后住院时间为4.2(1.0～8.0)d。1例下腹部切口疝合并肝硬化(肝功能B级)患者术后引流量多,每天约300 ml,经利尿、护肝等对症治疗后好转;8例患者术后4 d内出现原疝区域疼痛,1周后均缓解,无慢性疼痛等;4例患者术后CT检查提示原疝囊处积液,未经治疗,自行好转;1例巨大切口疝行腹膜前广泛分离患者术后出现低热,最高37.8℃,持续6 d后好转。随访5～12个月,患者均无复发和术区感染。结论腹腔镜下完全腹膜外修补术治疗切口疝安全有效。此术式可避免腹腔内补片植入术的诸多弊端,术中应用的逆向穿刺法也便于空间建立。腹腔镜下完全腹膜外修补术为腹壁切口疝的微创治疗提供了一个新的思路。
Objective To investigate the clinical effect of laparoscopic total extraperitoneal repair for incisional hernia.Methods A retrospective study was performed on 25 cases of patients with incisional hernia who were admitted from February 2016 to February 2017.Among them,9 cases of upper abdominal incisional hernia and 16 cases of lower abdominal incisional hernia.All patients received laparoscopic total extraperitoneal repair.Perioperative indicators and adverse reactions during follow-up were recorded.Results All of the surgeries were successfully performed.In patients with upper abdominal incision hernia,the mean operation time was 190(90-290) minutes,the average day of hospitalization was 4.1(1.0-7.0) days.The mean operation time and average day of hospitalization in patients with lower abdominal incision hernia was 157(60-245) minutes and 4.2(1.0-8.0) days,respectively.One case of lower abdominal incisional hernia complicated with cirrhosis(grade B liver function) had a large postoperative drainage volume,about 300 ml per day,which was improved after symptomatic treatment such as diuresis and liver protection.Eight patients presented pain in the area of the original hernia within 4 days after surgery,which was relieved after 1 week without chronic pain.Postoperative CT examination of 4 patients indicated hydrops in the hernia sac,which improved spontaneously without treatment.One case of huge incision hernia line postoperatively in patients with peritoneal widely separated before a low grade fever,37.8℃,the highest continuous improvement after 6 days.All patients were followed up for 5-12 months without recurrence or intraoperative infection.Conclusion Laparoscopic total extraperitoneal repair for incisional hernia is safe and effective.This method can avoid many disadvantages of intraperitoneal mesh implantation,and the reverse puncture method is also convenient for space establishment.Laparoscopic total extraperitoneal repair provides a new approach for minimally invasive treatment of abdominal incisional hernia.
Objective To investigate the clinical effect of laparoscopic total extraperitoneal repair for incisional hernia.Methods A retrospective study was performed on 25 cases of patients with incisional hernia who were admitted from February 2016 to February 2017.Among them,9 cases of upper abdominal incisional hernia and 16 cases of lower abdominal incisional hernia.All patients received laparoscopic total extraperitoneal repair.Perioperative indicators and adverse reactions during follow-up were recorded.Results All of the surgeries were successfully performed.In patients with upper abdominal incision hernia,the mean operation time was 190(90-290) minutes,the average day of hospitalization was 4.1(1.0-7.0) days.The mean operation time and average day of hospitalization in patients with lower abdominal incision hernia was 157(60-245) minutes and 4.2(1.0-8.0) days,respectively.One case of lower abdominal incisional hernia complicated with cirrhosis(grade B liver function) had a large postoperative drainage volume,about 300 ml per day,which was improved after symptomatic treatment such as diuresis and liver protection.Eight patients presented pain in the area of the original hernia within 4 days after surgery,which was relieved after 1 week without chronic pain.Postoperative CT examination of 4 patients indicated hydrops in the hernia sac,which improved spontaneously without treatment.One case of huge incision hernia line postoperatively in patients with peritoneal widely separated before a low grade fever,37.8℃,the highest continuous improvement after 6 days.All patients were followed up for 5-12 months without recurrence or intraoperative infection.Conclusion Laparoscopic total extraperitoneal repair for incisional hernia is safe and effective.This method can avoid many disadvantages of intraperitoneal mesh implantation,and the reverse puncture method is also convenient for space establishment.Laparoscopic total extraperitoneal repair provides a new approach for minimally invasive treatment of abdominal incisional hernia.
引文
[1] Sharma A,Mehrotra M,Khullar R,et al.Laparoscopic ventral/incisional hernia repair:a single centre experience of 1,242 patients over a period of 13 years[J].Hernia,2011,15(2):131-139.
[2] Heniford BT,Park A,Ramshaw BJ,et al.Laparoscopic repair of ventral hernias:nine years′ experience with 850 consecutive hernias[J].Ann Surg,2003,238(3):391-399.
[3] Cobb WS,Kercher KW,Matthews BD,et al.Laparoscopic ventral hernia repair:a single center experience[J].Hernia,2006,10(3):236-242.
[4] Arita NA,Nguyen MT,Nguyen DH,et al.Laparoscopic repair reduces incidence of surgical site infections for all ventral hernias[J].Surg Endosc,2015,29(7):1769-1780.
[5] Awaiz A,Rahman F,Hossain MB,et al.Meta-analysis and systematic review of laparoscopic versus open mesh repair for elective incisional hernia[J].Hernia,2015,19(3):449-463.
[6] Cavazzola LT,Rosen MJ.Laparoscopic versus open inguinal hernia repair[J].Surg Clin North Am,2013,93(5):1269-1279.
[7] Jiang H,Ma R,Zhang X.Novel retrograde puncture method to establish preperitoneal space for laparoscopic direct inguinal hernia repair with internal ring suturing[J].Braz J Med Biol Res,2016,49(6):e5247.
[8] 蒋会勇,马锐,郭一君,等.逆向穿刺法建立腹膜前间隙在腹腔镜全腹膜外疝修补术中的应用[J].腹腔镜外科杂志,2015,6:455-457.
[9] 蒋会勇,吴卫东,马锐,等.腹腔镜完全腹膜外补片修补切口疝3例[J].临床军医杂志,2018, 46(2):239-240.
[10] Cobb WS,Kercher KW,Heniford BT.Laparoscopic repair of incisional hernias[J].Surg Clin North Am,2005,85(1):91-103.
[2] Heniford BT,Park A,Ramshaw BJ,et al.Laparoscopic repair of ventral hernias:nine years′ experience with 850 consecutive hernias[J].Ann Surg,2003,238(3):391-399.
[3] Cobb WS,Kercher KW,Matthews BD,et al.Laparoscopic ventral hernia repair:a single center experience[J].Hernia,2006,10(3):236-242.
[4] Arita NA,Nguyen MT,Nguyen DH,et al.Laparoscopic repair reduces incidence of surgical site infections for all ventral hernias[J].Surg Endosc,2015,29(7):1769-1780.
[5] Awaiz A,Rahman F,Hossain MB,et al.Meta-analysis and systematic review of laparoscopic versus open mesh repair for elective incisional hernia[J].Hernia,2015,19(3):449-463.
[6] Cavazzola LT,Rosen MJ.Laparoscopic versus open inguinal hernia repair[J].Surg Clin North Am,2013,93(5):1269-1279.
[7] Jiang H,Ma R,Zhang X.Novel retrograde puncture method to establish preperitoneal space for laparoscopic direct inguinal hernia repair with internal ring suturing[J].Braz J Med Biol Res,2016,49(6):e5247.
[8] 蒋会勇,马锐,郭一君,等.逆向穿刺法建立腹膜前间隙在腹腔镜全腹膜外疝修补术中的应用[J].腹腔镜外科杂志,2015,6:455-457.
[9] 蒋会勇,吴卫东,马锐,等.腹腔镜完全腹膜外补片修补切口疝3例[J].临床军医杂志,2018, 46(2):239-240.
[10] Cobb WS,Kercher KW,Heniford BT.Laparoscopic repair of incisional hernias[J].Surg Clin North Am,2005,85(1):91-103.