单孔腹腔镜完全腹膜外补片修补术治疗成人脐疝13例报告  

Single-incision laparoscopic totally extraperitoneal sublay for adult umbilical hernia:a report of 13 cases

作　　者：胡伟泽 郑辉明[1] 戴育坚[1] HU Weize;ZHENG Huiming;DAI Yujian(Department of Hernia Surgery,Quanzhou First Hospital Affiliated to Fujian Medical University,Quanzhou,Fujian 362000,China)

机构地区：[1]福建医科大学附属泉州第一医院疝外科,福建泉州362000

出　　处：《中国普通外科杂志》2023年第10期1516-1521,共6页China Journal of General Surgery

基　　金：福建医科大学启航基金资助项目(2022QH1261)。

摘　　要：背景与目的:单孔腹腔镜技术(SILS)目前已被广泛应用于腹部手术中,但在脐疝修补术中的应用鲜见报道。笔者科室在前期成熟开展单孔腹腔镜腹股沟疝修补(TEP)手术的基础上,尝试使用单孔腹腔镜完全腹膜外补片修补术(SIL-TES)治疗成人脐疝并取得一定经验。本文探讨SIL-TES治疗成人脐疝的可行性与疗效。方法:回顾性分析2021年1月—2022年8月福建医科大学附属泉州第一医院疝外科13例行SIL-TES治疗的成人脐疝患者资料,其中,男性9例,女性4例,平均年龄为(38.9±6.1)岁,疝环平均直径(2.4±0.6)cm。SIL-TES的基本要求包括:以三孔腹腔镜完全腹膜外补片修补术为基础,配合单孔腹腔镜的操作技巧,扶镜手与主刀的默契配合,合理放置腹腔镜及器械,尽可能减少操作过程中出现的“筷子”效应;需熟练掌握腹壁的多层解剖,避免术中解剖层次错误、腹膜破损,导致补片不能放置于正确层面。结果:13例均顺利完成手术,无中转开放。手术时间平均(138.5±20.9)min,术后3 d疼痛评分2.5±0.9,术后留置引流管平均(4.1±1.1)d。术后平均住院时间3~6 d,中位时间4.1 d,无术区血清肿、出血、切口裂开、切口感染、脐部皮肤坏死、肠梗阻、肠瘘等并发症。平均随访时间(14.7±6.3)个月,无复发及慢性疼痛等。结论:采用SIL-TES治疗成人脐疝是可行的,可作为成人脐疝的补充手术方式,但碍于病例数少、随访时间短,远期疗效需进一步明确。Background and Aims:Single-incision laparoscopic surgery(SILS)has been widely utilized in abdominal surgeries,but its application in umbilical hernia repair has been limited.Building on the department's prior experience with single-incision laparoscopic inguinal hernia repair(TEP),the authors attempted to treat adult umbilical hernias using single-incision laparoscopic totally extraperitoneal sublay(SIL-TES)and gained certain experience.This study was to explore the feasibility and efficacy of SILTES for the treatment of adult umbilical hernia.Methods:The data from 13 adult umbilical hernia patients who underwent SIL-TES in Quanzhou First Hospital Affiliated to Fujian Medical University from January 2021 to August 2022 were retrospectively analyzed.Among these patients,there were 9 males and 4 females,with an average age of(38.9±6.1)years and an average hernia ring diameter of(2.4±0.6)cm.The requirements of SIL-TES included:building upon the three-port laparoscopic totally extraperitoneal sublay as the foundation,incorporating the techniques of single-incision laparoscopy,achieving seamless coordination between the cameraholding assistant and the primary surgeon,placing the laparoscope and instruments logically to minimize the"chopstick effect"during the procedure;proficiency in mastering the multi-layer anatomy of the abdominal wall for avoiding intraoperative anatomical errors and peritoneal damage,ensuring the mesh placed in the correct layer.Results:All 13 cases were successfully completed without any conversions to open surgery.The average operative time was(138.5±20.9)min,with an average postoperative pain score of 2.5±0.9 at postoperative day 3.The mean duration of postoperative drainage tube placement was(4.1±1.1)d.The average length of postoperative hospital stay was 3 to 6 d,with a median length of 4.1 d.No complications such as seroma,bleeding,wound dehiscence,wound infection,umbilical skin necrosis,bowel obstruction,or bowel fistula occurred.The average follow-up duration was(14.7±6.3)months,and

关 键 词：疝 脐 成年人 疝修补术 腹腔镜 

分 类 号：R656.2[医药卫生—外科学]