探讨经腹腔入路迟发性创伤性膈疝腹腔镜修补术的临床疗效。

回顾性分析2014年1月至2021年6月，在湖南省四家医院经腹腔入路腹腔镜修补术治疗的43例迟发性创伤性膈疝患者的临床资料。游离疝入胸腔的内容物还纳腹腔，采用可吸收2-0缝线或倒刺线关闭膈肌破裂孔，以疝环口为中心，按切口疝修补原则选择相应大小防粘连复合补片覆盖，中央区和周边采用3-0 prolene线缝合3针，其余部分采用3-0可吸收线间断缝合或倒刺线连续缝合，外侧部分也可以用疝螺旋钉将补片固定于膈肌上，以达到修补缺损的目的。术后每3个月采用电话和门诊方式进行随访，随访内容包括患者术后临床症状及疝复发情况。

43例迟发性创伤性膈疝患者均成功行腹腔镜膈疝无张力修补术，平均手术时间为174.5 min，术中平均出血量为75 ml，术后平均住院时间为12 d。32例患者术后出现较多淡血性胸腔积液，经治疗后恢复，12例患侧胸背部隐痛不适，经相应处理后消失。未出现呼吸、消化系统并发症，术前存在的呼吸系统症状和消化系统症状均缓解消失。所有患者均获得随访，随访时间为2年。截至随访时间，43例患者无严重术后并发症发生，无复发病例。

经腹腔入路迟发性创伤性膈疝腹腔镜修补术安全、可靠、创伤小、恢复快。

To investigate the clinical effects of laparoscopic repair of delayed traumatic diaphragmatic hernia through abdominal approach.

The clinical data of 43 patients with delayed traumatic diaphragmatic hernia who underwent transabdominal laparoscopic repair from January 2014 to June 2021 in four hospitals in Hunan Province were retrospectively analyzed. The contents of the hernia into the chest cavity were reduced to the abdominal cavity, and the rupture hole of the diaphragm was closed with absorbable 2-0 suture or barb wire. The hernia ring opening was centered on and the anti-adhesion composite mesh of the corresponding size was selected according to the incisional hernia repair principle, and the central area and surrounding area were sutured with 3-0 prolene with 3 stitches. The remaining parts were sutured continuously with 3-0 absorbable suture or barb wire. The outer part of the mesh can also be fixed on the diaphragm with the hernia screw nail to achieve the purpose of repairing the defect. Follow-up was conducted by telephone and outpatient interview every 3 months after surgery, including postoperative clinical symptoms and recurrence of hernia.

All 43 patients with delayed traumatic diaphragmatic hernia successfully underwent laparoscopic tension-free diaphragmatic hernia repair. The mean operation time was 174.5 min, the mean intraoperative blood loss was 75 ml, and the mean postoperative hospital stay was 12 days. There were 32 patients with more bloody pleural effusion after operation, which recovered after treatment, and 12 patients with dull pain and discomfort on the affected side of chest and back, which disappeared after corresponding treatment. There were no respiratory and digestive complications, and the respiratory and digestive symptoms that existed before surgery were relieved and disappeared. All patients were followed up for 2 years. Until the end of the follow-up, all the 43 patients had no serious postoperative complications and no recurrence.

Laparoscopic repair of delayed traumatic diaphragmatic hernia through abdominal approach is a safe, reliable, and minimally invasive method with rapid recovery.