剑脐入路内镜全腹膜外腹膜前修补术在上腹中线腹壁疝中的应用  

Endoscopic totally extraperitoneal procedure for preperitoneal repair of midline ventral hernias with xiphoid-umbilicus approach

作　　者：汤睿[1] 吴卫东[2] 蒋会勇 张威浩 张一忠 Tang Rui;Wu Weidong;Jiang Huiyong;Zhang Weihao;Zhang Yizhong(Department of Hernia and Abdominal Wall Surgery,East Hospital Affiliated to Tongji University,Shanghai 200120,China;Department of Gastrointestinal Surgery,Shanghai General Hospital,Shanghai 200080,China;Department Two of General Surgery,Northeast International Hospital,Shenyang 110000,China;Department of General Surgery,Shanghai United Family Hospital,Shanghai 200336,China;Department of Gastrointestinal Surgery,The Affiliated Hospital of Medical School of Ningbo University,Ningbo 315020,China)

机构地区：[1]同济大学附属东方医院疝与腹壁外科,上海200120 [2]上海交通大学附属第一人民医院胃肠外科,200080 [3]东北国际医院普外二科,沈阳110000 [4]上海和睦家医院普外科,200336 [5]宁波大学医学院附属医院胃肠外科,315020

出　　处：《中华腔镜外科杂志（电子版）》2020年第6期372-376,共5页Chinese Journal of Laparoscopic Surgery(Electronic Edition)

摘　　要：目的内镜完全腹膜外Sublay(totally extraperitoneal Sublay,TES)修补是近年治疗腹壁疝的新进展,腹膜前层面修补有助于进一步减轻腹壁创伤。笔者描述了剑脐入路内镜下全腹膜外途径的腹膜前修补上腹中线腹壁疝的初步尝试。方法回顾2019年10月至2020年4月采用该项手术的9例患者,记录与分析患者资料、疝与手术情况、术后情况与短期随访结果。结果9例患者均完成修补,手术时间(128±54)min,术后恢复快,无患者因并发症再次入院。无术中、术后严重并发症发生,仅1例术后发生血清肿。短期随访期间(2~6个月)无术区感染、疼痛、穿刺孔疝与复发等。结论腹膜前修补有助于进一步降低TES修补对腹壁的创伤;与耻骨上入路比较,剑脐入路能更方便进行中、上腹小型腹壁疝的腹膜前修补。Objective Endoscopic totally extraperitoneal Sublay(TES)repair seems to be a promising procedure for treating ventral hernia,repairing at the preperitoneal layer may further reduce the damage to the abdominal wall.This article reports the preliminary surgical results after such procedure with xiphoid-umbilicus approach for midline upper abdomen ventral hernia.Methods Nine cases performed with endoscopic totally extraperitoneal procedure for preperitoneal repair of midline ventral hernias with xiphoid-umbilicus approach were included,patient demographics,hernia characteristics,operative variables and surgical results were recorded and analyzed.Results All repairs were completed successfully,the operation during was(128±54)min.All patients recovered quickly and uneventfully and no case needed readmission.No severe intraoperative and postoperative complications occurred,only one case developed seroma.No surgical site infection,pain,trocar site hernia and recurrence were observed during short-term follow-up(2 to 6 months).Conclusions Endoscopic preperitoneal repair may help to reduce the damage to the abdominal wall during TES procedure.Comparing with suprapubic approach,xiphoid-umbilicus approach facilitates the preperitoneal repair for small ventral hernia of upper abdomen.

关 键 词：腹壁疝内镜Sublay修补 全腹膜外Sublay 全腹膜囊分离 剑脐入路 腹膜前修补 

分 类 号：R65[医药卫生—外科学]