腹腔镜完全腹膜外腹直肌后间隙成人脐疝修补术

doi:10.3877/cma.j.issn.1674-392X.2018.01.011

目的

探讨全腹腔镜下将补片置于腹膜前腹直肌后间隙进行脐疝修补效果。

方法

沈阳军区总医院2015年6月至2017年11月，共完成腹腔镜完全腹膜外肌后间隙脐疝补片修补术9例，其中男性5例，女性4例，平均年龄48.2（28～70）岁，术中采用全腹腔镜在腹直肌后方分离腹膜前间隙及脐疝缺损区，关闭缺损后将补片置于腹直肌后间隙内进行修补，对患者的临床资料进行回顾性分析。

结果

9例患者均顺利完成手术，平均手术时间100 min（73～130 min），术后平均住院时间1.8（1～3）d，发生脐部皮肤小面积坏死感染1例，脐部积液1例。无出血、肠梗阻、肠瘘等严重并发症，无复发及慢性疼痛。

结论

采用腹腔镜完全腹膜外肌后间隙放置补片的方法进行脐疝修补是可行的，避免了腹腔内补片修补手术的不足，限于病例数原因，尚需进一步观察后续结果。该术式为脐疝的腔镜治疗提供了一个新的方法。

关键词: 脐疝, 腹腔镜, 疝修补术, 逆向穿刺法

Objective

Intraperitoneal onlay mesh (IPOM) repair of umbilical hernia was expensive and elicited a number of complications. According to the concept of totally extraperitoneal (TEP) approaches, it was possible to obtain good results by laparoscopic preperitoneal placement of the mesh to repair the umbilical hernias.

Methods

A total of 9 cases oflaparoscopic totally extraperitoneal posterior rectus abdominisspaces mesh repair for umblical hernias in adults were completed in the general hospital of Shenyang military region from June 2015 to November 2017. The number of male and female was 5 and 4 cases, respectively. The average age was 48.2 (28-70) years. During the surgery, the preperitoneal space and umbilical hernia defects were laparoscopically separated. The mesh was placed in front of the peritoneum posterior rectus abdominisspaces after closed the umbilical hernia defects.

Results

All of the operations were successfully completed. The average operation time was 100 min (73-130 min); and the average day of hospitalization was 1.8 days (1-3 days). Skin of umbilical area necrosis and secondary infection occurred in one case. Seroma occurred in one case. No bleeding, intestinal obstruction, intestinal fistula nor other serious complications occurred in these patients. There were no recurrence and chronic pain found.

Conclusion

It is feasible to repair the umbilical hernia by laparoscopic totally extraperitoneal posterior rectus abdominisspaces mesh repair approaches, and this technique avoids many shortcomings of the IPOM surgery. Further follow-up results should be investigated because of limitednumber of cases and followed up time in this study. This procedure provides new insights into the minimally invasive treatment of umbilical hernia in adults.

Key words: Umbilical hernias, Laparoscopic, Herniorrhaphy, Retrograde puncture method

表1 9例腹腔镜脐疝手术患者基本资料

手术时间	性别	年龄(岁)	病案号	诊断	手术时间(min)	术后住院天数(d)	修补材料
2015-6-16	女	35	744972	脐疝,白线疝	96	2	强生USH下片
2015-9-25	男	28	760270	脐疝	85	2	强生USH下片
2017-5-26	男	70	819091	脐疝	126	1	柯惠10 cm×15 cm聚酯平片
2017-6-28	男	36	869851	脐疝	90	1	柯惠10 cm×15 cm聚酯平片
2017-07-03	男	41	870094	脐疝,腹直肌分离	130	3	强生超普平片
2017-08-03	女	45	485514	脐疝	110	2	柯惠10 cm×15 cm聚酯平片
2017-10-17	女	67	887412	脐疝	80	1	柯惠外科补片
2017-10-18	女	65	886834	脐疝	106	1	柯惠外科补片
2017-11-2	男	47	998078	脐疝	73	3	柯惠10 cm×15 cm聚酯平片

表1 9例腹腔镜脐疝手术患者基本资料

手术时间	性别	年龄(岁)	病案号	诊断	手术时间(min)	术后住院天数(d)	修补材料
2015-6-16	女	35	744972	脐疝,白线疝	96	2	强生USH下片
2015-9-25	男	28	760270	脐疝	85	2	强生USH下片
2017-5-26	男	70	819091	脐疝	126	1	柯惠10 cm×15 cm聚酯平片
2017-6-28	男	36	869851	脐疝	90	1	柯惠10 cm×15 cm聚酯平片
2017-07-03	男	41	870094	脐疝,腹直肌分离	130	3	强生超普平片
2017-08-03	女	45	485514	脐疝	110	2	柯惠10 cm×15 cm聚酯平片
2017-10-17	女	67	887412	脐疝	80	1	柯惠外科补片
2017-10-18	女	65	886834	脐疝	106	1	柯惠外科补片
2017-11-2	男	47	998078	脐疝	73	3	柯惠10 cm×15 cm聚酯平片

图2 直接在下腹部打孔的套管布局

图4 腹腔镜下显示脐疝疝囊的分离

图6 腹腔镜下放置补片

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Laparoscopic totally extraperitoneal posterior rectus abdominisspaces mesh repair for umbilical hernias in adults

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Laparoscopic totally extraperitoneal posterior rectus abdominisspaces mesh repair for umbilical hernias in adults