腹腔镜IPOM七步法修补术在创伤性腹壁疝中的应用  

Laparoscopic IPOM seven-step repair in traumatic abdominal wall hernia

作　　者：黄恩民 马宁[1] 马涛 刘创雄 黄浩男 汤福鑫 曾兵 李英儒[1] 江志鹏[1] 侯泽辉 甘文昌[1] 陈双[1] 周太成[1] Huang Enmin;Ma Ning;Ma Tao;Liu Chuangxiong;Huang Haonan;Tang Fuxin;Zeng Bing;Li Yingru;Jiang Zhipeng;Hou Zehui;Gan Wenchang;Chen Shuang;Zhou Taicheng(Department of Gastroenterological Surgery and Hernia Center,the Sixth Affiliated Hospital of Sun Yat-sen University,Guangdong Pro-vincial Key Laboratory of Colorectal and Pelvic Floor Diseases,Guangzhou510655,China)

机构地区：[1]中山大学附属第六医院胃肠、疝和腹壁外科,广东省结直肠盆底疾病研究重点实验室,广州510655

出　　处：《创伤外科杂志》2023年第4期261-266,共6页Journal of Traumatic Surgery

摘　　要：目的探讨腹腔镜内网片(intraperitoneal onlay mesh,IPOM)七步法修补术在创伤性腹壁疝(traumatic abdominal wall hernias,TAWH)中的应用价值。方法回顾性分析2018年1月—2022年10月中山大学附属第六医院胃肠、疝和腹壁外科收治的12例TAWH患者的临床资料和手术录像,其中男性9例,女性3例;年龄44~66岁,平均56.5岁;体质量指数(body mass index,BMI)平均(25.1±3.2)kg/m^(2),最大缺损长轴57~150mm,平均105.5mm,短轴45~105mm,平均68.5mm。致伤原因:道路交通伤10例,机器挤压伤2例。评价腹腔镜IPOM七步法(即腹腔内松解腹壁粘连后,关闭筋膜缺损并置入补片加强腹壁)修补TAWH的可行性,观察术后复发情况,并结合手术录像分析TAWH的特点、术中和术后并发症、术后恢复情况等。结果12例患者均顺利完成腹腔镜IPOM七步法修补术。术前行肉毒素腹横肌注射及渐进性气腹,未发现明显合并疾病。术中无结肠及小肠损伤病例,术后无肠瘘病例。术后恢复排气时间1~5d,平均2.3d,未出现手术部位感染。患者均在门诊进行体格检查,随访3~60个月,平均35.3个月,无复发病例。结论腹腔镜IPOM七步法修补术治疗TAWH是安全可行的。Objective To investigate the value of laparoscopic IPOM seven-step repair in traumatic abdom-inal wall hernia(TAWH).Methods Retrospective analysis was conducted on clinical data and surgical videos of 12 patients with TAWH admitted to the Department of Gastrointestinal,Hernia and Abdominal Wall Surgery of the Sixth Hospital of Sun Yat-sen University from Jan.2018 to Oct.2022,including 9 males and 3 females,with the mean age of 56.5(range 44-66)years and body mass index(BMI)of(25.1±3.2)kg/m^(2).The maximum defect was 57-150 mm for long axis,mean 105.5 mm and 45-105 mm for short axis,mean 68.5 mm.There were 10 cases of traffic accident injuries and 2 machine crush injuries.Laparoscopic IPOM seven-step repair(i.e.,intraperitoneal release of abdominal wall adhesions followed by closure of the fascial defect and placement of a patch to reinforce the abdominal wall)was conducted to repair TAWH.The surgical videos were reviewed to analyze the characteristics of TAWH.Intra-and post-operative complications,postoperative recovery and recurrence of TAWH were observed.Results All the 12 patients successfully completed the laparoscopic IPOM seven-step repair.No significant com-plications were found with preoperative botulinum toxin transversus abdominis injection and progressive pneumoper-itoneum.There were no cases of intraoperative injuries to the colon or small intestine,nor any postoperative intesti-nal fistula.The average time to resume venting after surgery ranged 1-5 d,2.3 d on average.No surgical site infec-tion was observed.All patients underwent follow-up for physical examination in the outpatient clinic,for 3-60 months,mean 35.3 months.No recurrence was reported.Conclusion Laparoscopic IPOM seven-step repair is safe and feasible in the treatment of TAWH.

关 键 词：创伤性腹壁疝 IPOM修补术 七步法 渐进性气腹 

分 类 号：R656.2[医药卫生—外科学]