腹腔镜或杂交技术修补大型、巨大型腹壁切口疝的技巧  

Skills of Laparoscopy or Hybrid Surgery for Large and Huge Incisional Abdominal Hernia

作　　者：王京立[1] 华玉明[1] 朱从元[1] 徐建敏[1] 

机构地区：[1]江苏省无锡市第三人民医院普通外科,无锡214041

出　　处：《中国微创外科杂志》2017年第3期276-278,共3页Chinese Journal of Minimally Invasive Surgery

基　　金：无锡市科技发展基金资助项目(2015-CSE31N1508)

摘　　要：目的探讨腹腔镜或杂交技术修补大型(缺损8~12 cm)、巨大型(缺损>12 cm)腹壁切口疝的操作技巧。方法 2009年7月~2015年6月,对45例腹壁切口疝进行修补,包括大型20例,巨大型25例。腹腔镜修补20例,杂交修补25例,均使用防粘连补片。结果腹腔镜修补和杂交修补手术的手术时间分别为(113.0±35.4)min、(127.0±31.6)min,术中出血(36.0±19.8)ml、(92.0±36.2)ml,术后住院时间(10.3±2.6)d、(11.0±2.2)d。无手术死亡、腹腔感染、切口感染发生,1例左下肢深静脉血栓形成经抗凝与活血化瘀治愈,2例切口血清肿穿刺加压包扎治愈,3例持续腹壁痛3个月后缓解。随访1~5年,(3.1±1.8)年,无疝复发。结论腹腔镜或杂交技术防粘连补片修补切口疝,具有创伤小、恢复快、复发率低等优点。操作时避免肠管损伤、修复腹壁缺损或封闭疝环、选择合适补片、可靠固定是关键。Objective To investigate the operation skills of laparoscopy or hybrid technique for large（ defect 8-12 cm） and giant（ defect 12 cm） ventral incisional hernia（ VIH） repair. Methods A retrospective analysis was made in 45 cases of VIH repair from July 2009 to June 2015,including 20 cases of large VIH and 25 cases of giant VIH. Of which,20 cases were repaired by laparoscopic method and 25 cases were repaired by hybrid technique. Mesh was used in all the patients. Results The operation time in laparoscopic VIH repair and hybrid technique repair was（ 113. 0 ± 35. 4） and（ 127. 0 ± 31. 6） min,the intraoperative bleeding was（ 36. 0 ± 19. 8） and（ 92. 0 ± 36. 2） ml,and the postoperative hospitalization time was（ 10. 3 ± 2. 6） and（ 11. 0 ± 2. 2） d,respectively. Among the cases,there were no operative death,abdominal infection or incision infection. Deep venous thrombosis occurred in one patient,and was cured by anticoagulant therapy and activating circulation to remove blood stasis. Seroma occurred in two patients,and was cured by puncture and pressure dressing. Three patients developed persistent abdominal pain which was relieved after three months. During a follow-up for 1-5 years（ average,3. 1 ± 1. 8 years）,there were no postoperative recurrence hernias.Conclusions Laparoscopy or hybrid technique for VIH repair has advantages of small trauma,quick recovery,and low recurrence rate. It is important to avoid damaging the bowel during operation,repair abdominal wall defects or close hernia ring,choose appropriate mesh and reliably fixed.

关 键 词：腹壁切口疝 修补术 腹腔镜 

分 类 号：R656.3[医药卫生—外科学]