腹腔镜腹股沟疝修补术(TAPP)  

Laparoscopic diaphragmatic hernia repair

作　　者：李健文[1] 王文瑞[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院普外科 上海市微创外科临床医学中心,200025

出　　处：《中华普外科手术学杂志（电子版）》2014年第3期20-20,共1页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：国家自然科学基金会基金项目(30873000)

摘　　要：此病例为女性斜疝患者,应用腹腔镜经腹腹膜前疝修补术(TAPP)治疗。腹腔镜治疗女性腹股沟疝有其特殊性,原因是女性患者的子宫圆韧带与腹膜非常致密,不象男性患者的精索那样可以轻易的做到"腹壁化(Parietalization)",因此补片往往无法覆盖在子宫圆韧带和腹膜之间。该手术有两个不同于男性患者的操作步骤:(1)游离疝囊至内环口水平即可,不强调子宫圆韧带的"腹壁化"。(2)补片剪一开口,绕过子宫圆韧带覆盖在其后方,而不是平铺在其前方。补片开口处可用缝合或医用胶等方法关闭,相当于进行内环口整形。This patient suffered from diaphragmatic hernia with incomplete colonic obstruction .The diaphragmatic hernia defect located at the inferior pole of the spleen , which was repaired under laparoscopy by using intraperitoneal onlay mesh procedure （ IPOM） .There are three key points of the procedure：firstly, to close the diaphragmatic hernia defect by suture before the insertion of mesh , namely “augmentation”instead of “bridging”;secondly , to cut off the splenophrenic ligament , and to mobilize the splenic flexure of the colon, which ensured enough coverage of the defect by mesh;thirdly, to fix mesh into the diagphragm by tacks should be strictly forbiddened .Fibrin glue was applied in this case .

关 键 词：疝 横膈 腹腔镜检查 

分 类 号：R656.21[医药卫生—外科学]