腹腔镜术后腹壁戳孔疝误诊原因分析  

Causes of Misdiagnosis of Trocar Site Hernia After Laparoscopic Surgery

作　　者：陈金辉 张摇 焦成 CHEN Jin-hui;ZHANG Yao;JIAO Cheng(The First Department of General Surgery,the 980th Hospital of PLA Joint Logistics Support Forces,Shijazhuang 050082,China)

机构地区：[1]解放军联勤保障部队第九八〇医院普外一科,石家庄050082

出　　处：《临床误诊误治》2022年第7期12-15,共4页Clinical Misdiagnosis & Mistherapy

摘　　要：目的 探讨腹腔镜术后腹壁戳孔疝的易发因素、误诊原因及防范措施。方法 回顾性分析2015年1月—2020年1月收治的3例腹腔镜术后腹壁戳孔疝误诊患者的临床资料,并复习相关文献。结果 本组误诊率为5.88%。1例于急性阑尾炎腹腔镜术后脐部戳孔处出现边界不清的肿物,伴压痛,误诊为炎性肉芽肿。1例于直肠腺癌腹腔镜术后右下腹壁辅助操作戳孔处发现结节,边界清楚,质地硬,误诊为直肠腺癌腹壁种植转移。1例于直肠腺癌腹腔镜术后出现腹胀,肠鸣音弱,误诊为炎性肠梗阻。2例再次手术治疗时诊断得以纠正,确诊为腹壁戳孔疝。1例给予保守治疗,后因发生急性腹膜炎,行急诊手术探查,发现部分小肠壁经左下腹戳孔疝出嵌顿,肠壁坏死、破裂,确诊为腹壁戳孔疝嵌顿。2例行疝修补术,1例行小肠部分切除术和疝修补术;均恢复良好,未发现戳孔疝复发。结论 腹壁戳孔疝是腹腔镜术后一种少见并发症。部分腹壁戳孔疝由于临床表现不典型,容易被误诊,尤其出现嵌顿、绞窄性疝的情况,处理不当或不及时,会引起严重后果。应引起腹部外科医生的足够重视。Objective To explore the risk factors, causes of misdiagnosis and preventive measures of Trocar site hernia after laparoscopic surgery. Methods The clinical data of 3 patients with misdiagnosed Trocar site hernia after laparoscopic surgery from January 2015 to January 2020 were retrospectively analyzed, and relevant literature was reviewed. Results The misdiagnosis rate in this group was 5.88%. In 1 case of acute appendicitis after laparoscopic surgery, an ill-defined mass with tenderness appeared at the umbilical hole, which was misdiagnosed as inflammatory granuloma. One case of rectal adenocarcinoma after laparoscopic surgery had a nodule at auxiliary operation site of the right lower abdominal wall, with clear boundary and hard texture, which was misdiagnosed as rectal adenocarcinoma implantation metastasis to abdominal wall. One case of rectal adenocarcinoma had abdominal distension and weak bowel sounds after laparoscopic surgery, which was misdiagnosed as inflammatory bowel obstruction. The diagnosis was corrected during reoperation in 2 cases, and it was diagnosed as Trocar site hernia. One case was given conservative treatment, and then received emergency surgical exploration due to acute peritonitis. It was found that part of the small intestinal wall was incarcerated through the left lower quadrant, and the intestinal wall was necrotic and ruptured. The diagnosis was incarcerated Trocar site hernia. Two cases underwent hernia repair, and 1 case underwent partial small bowel resection and hernia repair. All recovered well, and no recurrence of Trocar site hernia was found. Conclusion Trocar site hernia is a rare complication after laparoscopic surgery. Due to the atypical clinical manifestations of some Trocar site hernia, it is more likely to be misdiagnosed, especially in the case of incarcerated and strangulated hernias. Improper or untimely management will cause serious consequences, which, therefore, warrants attention by abdominal surgeons.

关 键 词：腹腔镜外科手术 戳孔疝 误诊 肉芽肿 肿瘤种植 肠梗阻 

分 类 号：R656.24[医药卫生—外科学]