切换至 "中华医学电子期刊资源库"

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]. 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]. 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
[1]
中华医学会外科学分会疝与腹壁外科学组, 中国医师协会外科医师分会疝和腹壁外科医师委员会. 腹壁切口疝诊断和治疗指南(2018年版)[J]. 中华外科杂志, 2018, 56(7): 499-502.
[2]
秦昌富, 陈杰, 申英末, 等. 基于中国疝病注册登记随访系统的腹外疝治疗现状分析与流行病学研究[J]. 中华消化外科杂志, 2021, 20(7): 785-789.
[3]
唐健雄, 李绍杰. 我国疝与腹壁外科发展和在新世纪创新挑战[J]. 中国实用外科杂志, 2020, 40(1): 89-92.
[4]
Bittner R, Bain K, Bansal V K, et al. Correction to: Update of Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias(International Endohernia Society(IEHS)- Part A[J]. Surg Endosc, 2019, 33: 3140-3142.
[5]
陈思宇, 赵渝. 腹壁切口疝复发因素及应对策略[J/OL]. 中华疝和腹壁外科杂志(电子版), 2018, 12(3): 161-164.
[6]
Fink C, Baumann P, Wente MN, et al. Incisional hernia rate 3 years after midline laparotomy[J]. Br J Surg, 2014, 101(2): 51-54.
[7]
李殿启, 崔伟, 李健, 等. 腹腔镜与传统开放修补术治疗超重与肥胖患者腹壁切口疝的对比分析[J/OL]. 中华普外科手术学杂志(电子版), 2017, 11(1): 43-45.
[8]
李赞林, 李义亮, 克力木, 等. 腹壁切口疝的外科治疗体会[J/OL]. 中华疝和腹壁外科杂志(电子版), 2017, 11(2): 101-104.
[9]
Kaoutzanis C, Leichtle SW, Mouawad NJ, et al. Risk factors for postoperative wound infections and prolonged hospitalization after ventral/incisional hernia repair[J]. Hernia, 2015, 19(1): 113-123.
[10]
陈双, 周太成. 腹壁的力学原理[J]. 中国实用外科杂志, 2021, 41(4): 371-373, 378.
[11]
中华医学会外科学分会疝与腹壁外科学组, 中国医疗保健国际交流促进会临床实用技术分会腹壁修复与重建外科学组. 腹壁缺损修复与重建中国专家共识(2019版)[J]. 中国实用外科杂志, 2019, 39(2): 101-109.
[12]
中华医学会外科学分会疝与腹壁外科学组. 腹腔内补片修补术中国专家共识(2022版)[J]. 中国实用外科杂志, 2022, 42(7): 721-729.
[13]
乐飞, 李健文. Sublay修补术的发展历程与展望[J]. 中华消化外科杂志, 2021, 20(7): 769-773.
[14]
吴立胜. 内镜下Sublay修补术的再认识[J]. 中华消化外科杂志, 2021, 20(7): 774-778.
[15]
Köckerling F, Hoffmann H, Mayer F, et al. What are the trends in incisional hernia repair? Real-world data over 10 years from the Herniamed registry[J]. Hernia, 2021, 25(2): 255-265.
[16]
Alizai PH, Lelaona E, Andert A, et al. Incisional hernia repair of medium-and large-sized defects: Laparoscopic IPOM versus open sublay technique[J]. Acta Chir Belg, 2019, 119(4): 231-235.
[17]
Kockerling F, Brunner W, Mayer F, et al. Asessment of potential influencing factors on the outcome in small(< 2 cm) umbilical hernia repair: a registry-based multivariable analysis of 31, 965 patients [J]. Hernia, 2021, 25(3): 587-603.
[18]
中华医学会外科学分会疝与腹壁外科学组, 中国医疗保健国际交流促进会临床实用技术分会腹壁修复与重建外科学组. 组织结构分离技术规范化操作中国专家共识(2020版)[J]. 中国实用外科杂志, 2020, 40(5): 488-493.
[19]
Thomas J D, Gentle C K, Krpata D M, et al. Comparing rates of bowel injury for laparoscopic and robotic ventral hernia repair: a retrospective analysis of the abdominal core health quality collaborative.[J]. Hernia, 2022, 26(5): 1251-1258.
[20]
Chelala E, Baraké H, Estievenart J, et al. Long-term outcomes of 1326 laparoscopic incisional and ventral hernia repair with the routine suturing concept: a single institution experience[J]. Hernia, 2016, 20(1): 101-110.
[21]
Christoffersen M W, Westen M, Rosenberg J, et al. Closure of the fascial defect during laparoscopic umbilical hernia repair: A randomized clinical trial[J]. Br J Surg, 2020, 107(3): 200-208.
[22]
江志鹏, 周太成, 曾兵, 等. 一种切口疝缝合的创新技术——"立体"缝合[J]. 中国实用外科杂志, 2021, 41(2): 160-163.
[23]
Andrea Balla, Isaias Alarcón, Salvador Morales-Conde. Minimally invasive component separation technique for large ventral hernia: which is the best choice? A systematic literature review[J]. Surg Endosc, 2020, 34(1): 14-30.
[24]
中华医学会外科学分会. 腹腔镜疝与腹壁外科手术缝合技术与缝合材料选择中国专家共识(2021版)[J]. 中国实用外科杂志, 2021, 41(5): 515-523.
[1] 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.
[2] 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.
[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] 吴畏, 吴永哲, 李宗倍, 崔宏力, 李华志, 许臣. 轻质大网孔补片腹腔镜下疝修补术治疗老年腹股沟疝的疗效及炎症因子的影响[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 70-73.
[11] 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.
[12] 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.
[13] 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.
[14] 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.
[15] 林文斌, 郑泽源, 郑文能, 郁毅刚. 外伤性脾破裂腹腔镜脾切除术患者中转开腹风险预测模型构建[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 619-623.
阅读次数
全文


摘要