切换至 "中华医学电子期刊资源库"
高级检索
中华疝和腹壁外科杂志(电子版)

中华疝和腹壁外科杂志(电子版) ›› 2018, Vol. 12 ›› Issue (01) : 47 -50. doi: 10.3877/cma.j.issn.1674-392X.2018.01.011

所属专题： 文献；

论著

腹腔镜完全腹膜外腹直肌后间隙成人脐疝修补术
蒋会勇1, 郭一君1, 张丹1, 马锐1, 张雪峰1,†()   
  1. 1. 110016　沈阳军区总医院普通外科
  • 收稿日期:2017-11-16 出版日期:2018-02-15
  • 通信作者: 张雪峰

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

Huiyong Jiang1, Yijun Guo1, Dan Zhang1, Rui Ma1, Xuefeng Zhang1,†()   

  1. 1. Department of General Surgery, the General Hospital of Shenyang Military Region, Shenyang 110016, China
  • Received:2017-11-16 Published:2018-02-15
  • Corresponding author: Xuefeng Zhang
  • About author:
    Correspondence author: Zhang Xuefeng, Email:
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

蒋会勇, 郭一君, 张丹, 马锐, 张雪峰. 腹腔镜完全腹膜外腹直肌后间隙成人脐疝修补术[J]. 中华疝和腹壁外科杂志(电子版), 2018, 12(01): 47-50.

Huiyong Jiang, Yijun Guo, Dan Zhang, Rui Ma, Xuefeng Zhang. Laparoscopic totally extraperitoneal posterior rectus abdominisspaces mesh repair for umbilical hernias in adults[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2018, 12(01): 47-50.

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
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
[1]
Sharma A,Mehrotra M,Khullar R, et al. Laparoscopic ventral/ incisional hernia repair: a single centre experience of 1, 242 patients over a period of 13 years[J]. Hernia, 2011, 15(2): 131-139.
[2]
Marx L,Raharimanantsoa M,Mandala S, et al. Laparoscopic treatment of incisional and primary ventral hernia in morbidly obese patients with a BMI over 35[J]. Surg Endosc, 2014, 28(12): 3310-3314.
[3]
Cassie S,Okrainec A,Saleh F, et al. Laparoscopic versus open elective repair of primary umbilical hernias: short-term outcomes from the American College of Surgeons National Surgery Quality Improvement Program[J]. Surg Endosc, 2014, 28(3): 741-746.
[4]
赛甫丁·艾比布拉,艾克拜尔·艾力,于文庆, 等. 腹腔镜下成人脐疝修补术的临床应用[J/CD]. 中华疝和腹壁外科杂志(电子版), 2016, 10(5): 361-363.
[5]
Arita NA,Nguyen MT,Nguyen DH, et al. Laparoscopic repair reduces incidence of surgical site infections for all ventral hernias[J]. Surg Endosc, 2015, 29(7): 1769-1780.
[6]
Awaiz A,Rahman F,Hossain MB, et al. Meta-analysis and systematic review of laparoscopic versus open mesh repair for elective incisional hernia[J]. Hernia, 2015, 19(3): 449-463.
[7]
Cavazzola LT,Rosen MJ. Laparoscopic versus open inguinal hernia repair[J]. Surg Clin North Am, 2013, 93(5): 1269-1279.
[8]
李健文,王明刚,唐健雄, 等. 腹股沟疝腹腔镜手术规范化操作指南[J/CD]. 中华疝和腹壁外科杂志(电子版), 2013, 7(5): 505-512.
[9]
Jiang H,Ma R,Zhang X. Novel retrograde puncture method to establish preperitoneal space for laparoscopic direct inguinal hernia repair with internal ring suturing[J]. Braz J Med Biol Res, 2016, 49(6): e5247.
[10]
蒋会勇,马锐,郭一君, 等. 逆向穿刺法建立腹膜前间隙在腹腔镜全腹膜外疝修补术中的应用[J]. 腹腔镜外科杂志, 2015, 20(6): 455-457.
[11]
Carbajo MA,Martp dOJC,Blanco JI, et al. Laparoscopic approach to incisional hernia[J]. Surg Endosc, 2003, 17(1): 118-122.
[12]
Garrard CL,Clements RH,Nanney L, et al. Adhesion formation is reduced after laparoscopic surgery[J]. Surg Endosc, 1999, 13(1): 10-13.
[13]
GPC Y. From intraperitoneal onlay mesh repair to preperitoneal onlay mesh repair[J]. Asian J Endosc Surg, 2017, 10(2): 119-127.
[14]
Chowbey PK,Sharma A,Khullar R, et al. Laparoscopic ventral hernia repair with extraperitoneal mesh: surgical technique and early results[J]. Surg Laparosc Endosc Percutan Tech, 2003, 13(2): 101-105.
[15]
Schwarz J,Reinpold W,Bittner R. Endoscopic mini/less open sublay technique(EMILOS)-a new technique for ventral hernia repair[J]. Langenbecks Arch Surg, 2017, 402(1): 173-180.
[1] 曹迪, 张玉茹. 经腹腔镜生物补片修补直肠癌根治术后盆底疝1例[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 115-116.
[2] 李凯, 陈淋, 向涵, 苏怀东, 张伟. 一种U型记忆合金线在经脐单孔腹腔镜阑尾切除术中的临床应用[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 15-15.
[3] 杜晓辉, 崔建新. 腹腔镜右半结肠癌D3根治术淋巴结清扫范围与策略[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 5-8.
[4] 周岩冰, 刘晓东. 腹腔镜右半结肠癌D3根治术消化道吻合重建方式的选择[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 9-13.
[5] 张焱辉, 张蛟, 朱志贤. 留置肛管在中低位直肠癌新辅助放化疗后腹腔镜TME术中的临床研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 25-28.
[6] 王春荣, 陈姜, 喻晨. 循Glisson蒂鞘外解剖、Laennec膜入路腹腔镜解剖性左半肝切除术临床应用[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 37-40.
[7] 李晓玉, 江庆, 汤海琴, 罗静枝. 围手术期综合管理对胆总管结石并急性胆管炎患者ERCP +LC术后心肌损伤的影响研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 57-60.
[8] 甄子铂, 刘金虎. 基于列线图模型探究静脉全身麻醉腹腔镜胆囊切除术患者术后肠道功能紊乱的影响因素[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 61-65.
[9] 逄世江, 黄艳艳, 朱冠烈. 改良π形吻合在腹腔镜全胃切除消化道重建中的安全性和有效性研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 66-69.
[10] 唐健雄, 李绍杰. 不断推进中国腹腔镜疝手术规范化[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 591-594.
[11] 田文, 杨晓冬. 腹腔镜腹股沟疝修补术式选择及注意事项[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 595-597.
[12] 李涛, 陈纲, 李世拥. 腹腔镜下右侧腹股沟斜疝修补术（TAPP）[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 598-598.
[13] 易明超, 汪鑫, 向涵, 苏怀东, 张伟. 一种T型记忆金属线在经脐单孔腹腔镜胆囊切除术中的临床应用[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 599-599.
[14] 莫波, 王佩, 王恒, 何志军, 梁俊, 郝志楠. 腹腔镜胃癌根治术与改良胃癌根治术治疗早期胃癌的疗效[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 644-647.
[15] 鲁鑫, 许佳怡, 刘洋, 杨琴, 鞠雯雯, 徐缨龙. 早期LC术与PTCD续贯LC术治疗急性胆囊炎对患者肝功能及预后的影响比较[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 648-650.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号