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中华疝和腹壁外科杂志(电子版) ›› 2022, Vol. 16 ›› Issue (06) : 658 -662. doi: 10.3877/cma.j.issn.1674-392X.2022.06.011

临床论著

腹腔镜下腹腔内补片修补术治疗腹壁切口疝的临床研究
陈育洪1, 王婕2, 陈俊勇1, 龙连生1, 谢正勇1, 丁洪亮1, 程黎阳1,()   
  1. 1. 510010 广州,中国人民解放军南部战区总医院普通外科
    2. 510010 广州,中国人民解放军南部战区总医院麻醉科
  • 收稿日期:2022-01-14 出版日期:2022-12-18
  • 通信作者: 程黎阳

Clinical study of laparoscopic intraperitoneal onlay mesh technique for the treatment of abdominal incisional hernia

Yuhong Chen1, Jie Wang2, Junyong Chen1, Liansheng Long1, Zhengyong Xie1, Hongliang Ding1, Liyang Cheng1,()   

  1. 1. Department of General Surgery, the General Hospital of Southern Theater Command, PLA, Guangzhou, Guangdong 510010, China
    2. Department of Anesthesiology, the General Hospital of Southern Theater Command, PLA, Guangzhou, Guangdong 510010, China
  • Received:2022-01-14 Published:2022-12-18
  • Corresponding author: Liyang Cheng
引用本文:

陈育洪, 王婕, 陈俊勇, 龙连生, 谢正勇, 丁洪亮, 程黎阳. 腹腔镜下腹腔内补片修补术治疗腹壁切口疝的临床研究[J/OL]. 中华疝和腹壁外科杂志(电子版), 2022, 16(06): 658-662.

Yuhong Chen, Jie Wang, Junyong Chen, Liansheng Long, Zhengyong Xie, Hongliang Ding, Liyang Cheng. Clinical study of laparoscopic intraperitoneal onlay mesh technique for the treatment of abdominal incisional hernia[J/OL]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2022, 16(06): 658-662.

目的

探讨腹腔镜下腹腔内补片修补术(IPOM)治疗腹壁切口疝的安全性及可行性。

方法

回顾性分析2014-2019年中国人民解放军南部战区总医院对103例腹壁切口疝患者实施腹腔镜下IPOM的临床资料,观察其手术时间、术后排气时间、术后住院时间、并发症及复发情况。

结果

103例患者均顺利完成手术,平均手术时间、术后排气时间及术后住院时间分别为(100±10)min、(40±8)h及(7.5±1.5)d。术中发现1例合并脐疝同时行脐疝修补,1例合并右侧腹股沟直疝同时行TAPP术,1例嵌顿性肠梗阻并肠坏死同时行肠切除吻合术。术后轻微并发症经短期治疗后痊愈,随访3~24个月,均无切口疝复发。

结论

腹腔镜下IPOM治疗腹壁切口疝具有安全、有效、创伤小、可发现隐匿疝、术后康复快、能降低并发症、缩短住院时间、复发率低等优点。

Objective

To discuss the safety and feasibility of the laparoscopic intraperitoneal onlay mesh technique for the treatment of abdominal incisional hernia.

Methods

The clinical data of 103 patients undergoing laparoscopic intraperitoneal onlay mesh technique for abdominal incisional hernias in the General Hospital of the Southern Theater from 2014 to 2019 were retrospectively analyzed. Observing the operation time, postoperative exhaust time, hospitalization time, complications and recurrence.

Results

All operations were successfully completed. The average operation time, postoperative exhaust time and hospitalization time were (100±10) min, (40±8) h and (7.5±1.5) d, respectively. During the operation, one case was found to be combined with an umbilical hernia and we performed a hernioplasty. Another case was combined with right direct inguinal hernia and we performed transabdominal preperitoneal hernia repair . The third case with incarcerated intestinal obstruction was combined with intestinal necrosis, and we performed enterotomy anastomosis. Minor postoperative complications were resolved with short-term treatment. All patients were followed for 3 to 24 months without hernia recurrence.

Conclusion

Laparoscopic intraperitoneal onlay mesh technique for the treatment of abdominal incisional hernias is safe, effective, minimally invasive, and has the advantages of occult hernia detection, rapid recovery, a low complication rate, a short hospitalization time, a low recurrence rate, etc.

图1 内镜组织结构分离前解剖,腹直肌前鞘半月线外侧1~2 cm纵行切开腹外斜肌腱膜与腹外斜肌
图2 内镜组织结构分离后解剖,显露腹外斜肌、腹外-腹内斜肌间隙,充分游离两层组织使腹直肌-腹内斜肌-腹横肌复合体向内侧推进
图3 疝缺损关闭
图4 疝外科补片悬吊与固定
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