腹腔镜手术治疗慢性创伤性膈疝的临床效果  

Clinical analysis of laparoscopic treatment of chronic traumatic diaphragmatic hernia in 29 cases

作　　者：程玉刚 刘俏男 栾立 崔常晋 闫治波[2] 李波 张光永 Cheng Yugang;Liu Qiaonan;Luan Li;Cui Changjin;Yan Zhibo;Li Bo;Zhang Guangyong(Department of Hernia and Abdominal Wall Surgery,Center of General Surgery,the First Affiliated Hospital of Shandong First Medical University,Shandong Provincial Qianfoshan Hospital,Jinan 250014,China;Department of Gastrointestinal Surgery,Qilu Hospital of Shandong University,Jinan 250012,China)

机构地区：[1]山东第一医科大学第一附属医院、山东省千佛山医院、普外中心疝与腹壁外科,济南250014 [2]山东大学齐鲁医院胃肠外科,济南250012

出　　处：《中华外科杂志》2023年第6期474-480,共7页Chinese Journal of Surgery

摘　　要：目的探讨腹腔镜个体化手术方案治疗慢性创伤性膈疝的临床效果。方法回顾性分析2015年6月至2023年1月山东大学齐鲁医院、山东第一医科大学第一附属医院收治的29例慢性创伤性膈疝患者的临床资料。男性21例,女性8例,年龄(49.4±17.8)岁(范围:19~79岁),4例无症状。患者均接受腹腔镜治疗。统计术中探查情况(膈疝位置、疝内容物、疝环最大径),手术情况(手术修补方案、手术时间、出血量、术后并发症)和术后随访情况。结果27例顺利完成腹腔镜下修补,其中单纯缝合6例,缝合+补片修补17例,腹前壁肌瓣翻转缝合+补片修补3例,补片桥接修补1例。手术时间(112.8±44.7)min(范围:60~200 min),术中出血量[M(IQR)]35(58)ml(范围:10~300 ml)。其余2例患者中转开腹。1例横结肠绞窄坏死患者术后死于肺部感染加重,余28例患者顺利出院,术后住院时间(4.9±2.2)d(范围:3~12 d)。术后随访36(24)个月(范围:1~60个月),2例患者偶有左上腹部不适;27例左侧膈疝患者随访期内未出现膈疝复发,1例右侧膈疝患者症状较术前缓解。结论根据膈肌缺损的位置、范围及疝环是否完整等情况采取腹腔镜个体化手术修补方案治疗慢性创伤性膈疝,可取得良好的治疗效果。Objective To examine the safety and effectiveness of laparoscopic individualized surgical treatment for chronic traumatic diaphragmatic hernia(CTDH).Methods The clinical data and follow-up data of 29 CTDH cases admitted to the Qilu Hospital of Shandong University or the First Affiliated Hospital of Shandong First Medical University from June 2015 to January 2023 were retrospectively analyzed.There were 21 males and 8 females,aged(49.4±17.8)years(range:19 to 79 years).The main clinical manifestations were symptoms of the digestive system and respiratory system,and only 4 cases were asymptomatic.All patients received laparoscopic treatment(conversion to open surgery was not excluded).Intraoperative exploration(location of the hernia,contents of the hernia,diameter of the hernia ring),surgical conditions(surgical repair plan,operation time,blood loss,postoperative complications)and postoperative follow-up were analyzed and discussed.Results Laparoscopic repair was successfully completed in 27 cases,including simple suture in 6 cases,suture and patch repair in 17 cases,the anterior abdominal wall muscle flap reversal suture and patch repair of in 3 cases,and patch bridge repair in 1 case.The operation time was(112.8±44.7)minutes(range:60 to 200 minutes).The amount of bleeding(M(IQR))was 35(58)ml(range:10 to 300 ml).The other 2 patients were converted to laparotomy.Except for one patient with transverse colon strangulation necrosis who died of aggravated pulmonary infection after surgery,the remaining 28 patients were discharged successfully.The follow-up time was 36(24)months(range:1 to 60 months).During the follow-up period,only two patients had occasional left upper abdominal discomfort.Twenty-seven patients with left diaphragmatic hernia had no recurrence,and the symptoms of 1 patient with right diaphragmatic hernia were relieved.Conclusion Customized laparoscopic surgical repair for CTDH according to the location and size of the diaphragmatic defect can achieve good surgical results.

关 键 词：疝 横膈 创伤性 腹腔镜检查 疝修补 治疗结果 

分 类 号：R655.6[医药卫生—外科学]