增强视野完全腹膜外疝修补术在中线腹壁疝的应用  

Enhanced view totally extraperitoneal technique for repair of midline ventral hernias

作　　者：罗宏宇 刘小飞 李国权 徐元庆 胡雄威 Luo Hongyu;Liu Xiaofei;Li Guoquan;Xu Yuanqing;Hu Xiongwei(Department of General Surgery,The Sixth People's Hospital of Huizhou,Huizhou 516211,China)

机构地区：[1]惠州市第六人民医院普通外科,广东516211

出　　处：《中华疝和腹壁外科杂志（电子版）》2021年第4期357-360,共4页Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition)

基　　金：惠州市科技计划项目(190411114572619)。

摘　　要：目的探讨增强视野完全腹膜外疝修补术(eTEP)在中线腹壁疝的应用价值,阐述手术操作流程及技术细节,分析其安全性和有效性。方法回顾分析2019年1月至2020年1月惠州市第六人民医院接受eTEP技术治疗的中线腹壁疝患者,位于中上腹的疝采用尾侧入路的eTEP技术;而中下腹的疝缺损采取头侧入路的eTEP技术。分析围手术期情况、手术效果及术后随访情况。结果本研究最终纳入患者18例,其中脐疝7例,白线疝6例,上腹部切口疝3例,下腹切口疝2例。手术均成功,其中采用尾侧入路eTEP手术13例,头侧入路eTEP手术5例。平均手术时间130 min(90~200 min),出血量少。疝环缺损横径平均3.3 cm。手术使用补片大小长径15~25 cm,横径13~17 cm。术后伤口疼痛轻微,术后第1天平均视觉模拟疼痛评分2.6分(1~4分)。术后平均住院时间4.6 d(3~7 d)。术后平均随访13个月,未发现复发。结论eTEP技术治疗中线腹壁疝安全而微创,无需防粘连补片及有创固定,节省费用,是治疗中线腹壁疝的一种技术选择。Objective To investigate a novel minimally invasive approach(enhanced-view totally extraperitoneal technique,eTEP)for the repair of midline ventral hernias.The procedure was described in details,and the safety and efficacy was evaluated.Methods Retrospective review of consecutive endoscopic retromuscular hernia repair cases utilizing the eTEP technique from the sixth people's hospital of Huizhou between January 2019 and January 2020 was conducted.The hernias of middle and upper abdomen were treated by a bottom-up(cephalad)eTEP repair,while the middle and lower abdomen hernias were treated by top-down eTEP repair.The perioperative data and postoperative complications will be collected and evaluated.Results Eighteen patients were included in our cohort,with 7 cases of umbilical hernia,6 epigastric primary hernia,3 epigastric incisional hernia and 2 hypogastric incisional hernia.All operations were successfully performed without conversion.Thirteen cases were conducted by bottom-up eTEP approach and the rest were treated by top-down approach.The mean operative time,postoperative pain and length of hospital stay were 130 min,2.6(VAS)and 4.6 days,respectively.The mean width of hernia defect was 3.3 cm.The length of mesh was ranged from 15-25 cm,and the width was 13-17 cm.During a mean follow-up of 13 months,no recurrence was observed.Conclusion The eTEP technique is safe and feasible for midline defect repair.It combines the advantages of MIS surgery,requires neither expensive anti-adhesive barrier mesh nor traumatic fixation,making it a cost-effective alternative for midline ventral hernia repair.

关 键 词：腹壁疝 完全腹膜外疝修补术 增强视野 内镜下疝修补 

分 类 号：R656.2[医药卫生—外科学]