白线疝17例临床诊治体会  

Diagnosis and treatment of linea alba hernia:a report of 17 cases

作　　者：谢天皓 李晓龙 牛征 孙新利 刘立涛[1] 王强[1] 张景 任项项 孙谦[1] 靳小石[1] Xie Tianhao;Li Xiaolong;Niu Zheng;Sun Xinli;Liu Litao;Wang Qiang;Zhang Jing;Ren Xiangxiang;Sun Qian;Jin Xiaoshi(Department of General Surgery,Affiliated Hospital,Hebei University,Hebei Baoding 071000,China;Department of Traumatology,First Hospital,Hebei Medical University,Hebei Shijiazhuang 050000,China)

机构地区：[1]河北大学附属医院普通外科,河北保定071000 [2]河北医科大学第一医院创伤外科,河北石家庄050000

出　　处：《腹部外科》2022年第5期367-369,374,共4页Journal of Abdominal Surgery

基　　金：河北省卫生健康委医学科学研究课题计划项目(20211642);河北省重点研发计划项目(21377773D)。

摘　　要：目的探讨白线疝的临床表现及手术疗效。方法回顾性分析2016年1月至2019年6月河北大学附属医院收治的17例白线疝病人的临床资料。结果17例均经手术证实为白线疝,术后随访(11.2±4.5)个月(6~18个月)。(1)8例行开放手术,平均手术时间为125 min(95~175 min)。其中嵌顿性白线疝3例,均为小肠嵌顿,2例切除坏死小肠后,1例行疝环关闭,1例疝环关闭后使用生物补片进行腹直肌后置补片修补(Sublay法),3例中另1例还纳无坏死小肠后行腹直肌前置补片修补(Onlay法),均无并发症出现;余5例开放手术中有4例行疝环关闭+Sublay修补,术后1例出现慢性疼痛,另1例行Onlay修补,未行疝环关闭,术后8个月时疝复发。(2)9例行腔镜手术,平均手术时间为100 min(78~124 min);其中2例行腹腔镜腹腔内补片修补术(IPOM),1例术后1周即出现假性复发;余7例行缝合疝环关闭联合IPOM,随访期间无并发症发生。结论术中还纳、切除嵌入的肝圆韧带或脐正中韧带以及关闭疝环行强化修补,是缓解腹壁牵涉痛和降低术后复发的有效手段。Objective To explore the clinical manifestations and surgical outcomes of linea alba hernia(LAH).Methods From January 2016 to June 2019,clinical data were retrospectively reviewed for 17 LAH patients.Results They were confirmed surgically as LAH and the average postoperative follow-up period was(11.2±4.5)(6-18)months.The average open operative duration was 125(95-175)min and the average endoscopic operative duration 100(78-124)min.Among three cases of small intestine incarceration,there were resection of necrotic small intestine(n=2),repairing with a biologic mash using Sublay method(n=1)and Onlay method(n=1).No complication occurred.Among five cases of open surgery,hernia ring closure plus Sublay repair(n=4)and Onlay repair without ring closure(n=1).The latter case recurred at 8 months post-operation.Among 9 cases of endoscopy,laparoscopic intraperitoneal Onlay mesh(IPOM,n=2)and ring closure plus IPOM(n=7)were performed.One case of IPOM alone recurred at 1 week post-operation.No complication occurred during follow-ups.Conclusion Restoration or resection of inserted ligamentum teres hepatis or middle umbilical ligament,and repairation with mesh after hernia ring suturing are effective in relieving abdominal wall referred pain and reducing postoperative recurrence.

关 键 词：白线疝 腹壁疝 腹腔镜手术 并发症 

分 类 号：R656.24[医药卫生—外科学]