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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) ›› 2024, Vol. 18 ›› Issue (02) : 208 -213. doi: 10.3877/cma.j.issn.1674-392X.2024.02.016

论著

完全腔镜下腹直肌后修补术治疗产后腹直肌分离经验分享
李斌1, 康欣2, 宋应寒3, 雷文章3,†()   
  1. 1. 610000　成都，四川大学华西医院胃肠外科；610299　成都，四川大学华西空港医院普外科
    2. 610299　成都，四川大学华西空港医院普外科
    3. 610000　成都，四川大学华西医院胃肠外科
  • 收稿日期:2023-07-12 出版日期:2024-04-18
  • 通信作者: 雷文章
  • 基金资助:
    四川省科技厅重点项目(2022YFS0230)

Experience sharing of totally extraperitoneal sublay repair under complete endoscopy for diastasis rectus abdominis after delivery

Bin Li1, Xin Kang2, Yinghan Song3, Wenzhang Lei3,†()   

  1. 1. Department of Gastrointestinal Surgery, West China Hospital of Sichuan University, Chengdu 610000, Sichuan, China; Department of General Surgery, West China (Airport) Hospital Sichuan University, Chengdu 610299, Sichuan, China
    2. Department of General Surgery, West China (Airport) Hospital Sichuan University, Chengdu 610299, Sichuan, China
    3. Department of Gastrointestinal Surgery, West China Hospital of Sichuan University, Chengdu 610000, Sichuan, China
  • Received:2023-07-12 Published:2024-04-18
  • Corresponding author: Wenzhang Lei
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李斌, 康欣, 宋应寒, 雷文章. 完全腔镜下腹直肌后修补术治疗产后腹直肌分离经验分享[J]. 中华疝和腹壁外科杂志(电子版), 2024, 18(02): 208-213.

Bin Li, Xin Kang, Yinghan Song, Wenzhang Lei. Experience sharing of totally extraperitoneal sublay repair under complete endoscopy for diastasis rectus abdominis after delivery[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2024, 18(02): 208-213.

目的

探讨完全腹腔镜下腹直肌后修补手术（TES）微创治疗产后腹直肌分离（DRA）的临床疗效。

方法

对2022年3—7月四川大学华西医院收治的4例产后DRA患者的临床资料进行分析，患者均行TES术，腹直肌后置入15 cm×20 cm聚丙烯疝修补网片加强修复，无需钉枪固定，无需防粘连补片。观察患者术中及术后恢复情况，采用门诊、微信及电话联系进行术后随访，记录患者术后恢复及并发症发生情况。

结果

4例患者均顺利完成完全TES手术，无中转开腹，2例合并脐疝，1例合并白线疝，平均手术时间168 min，术后第1天数字分级法疼痛评分平均为2分，术后拔除引流管时间约2.5 d，术后无并发症发生，术后平均住院时间为3.5 d。4例患者均获得术后随访，随访时间分别为术后1、3、6、9、12个月，无复发病例，无并发症发生。

结论

TES治疗产后DRA是安全、经济、有效的。

关键词: 腹直肌分离, 腹直肌后修补, 腹腔镜, 疝修补术, 补片
Objective

To investigate the clinical effect of minimally invasive totally extraperitoneal sublay (TES) repair for treatment of diastasis rectus abdominis (DRA) after delivery.

Methods

The clinical data of four postpartum DRA patients treated at West China Hospital of Sichuan University from March to July 2022 were analyzed. All patients underwent TES surgery, with a 15 cm×20 cm polypropylene hernia repair mesh placed posterior to the rectus abdominis for reinforcement repair, without the need for staple gun fixation or anti-adhesion mesh. Patients' intraoperative and postoperative recovery conditions were observed. Postoperative follow-up was conducted through outpatient visits, WeChat, and telephone contacts to record patients' recovery and the occurrence of complications.

Results

All four patients successfully completed the TES procedure without conversion to open surgery. Two cases had concurrent umbilical hernias, and one had a linea alba hernia. The average surgery duration was 168 minutes, with a postoperative day 1 numeric pain rating scale average score of 2, and an approximate 2.5 days until drainage tube removal. No postoperative complications occurred, and the average post-hospital stay was 3.5 days. All 4 patients were followed up postoperatively at 1, 3, 6, 9, and 12 months, with no cases of recurrence or complications.

Conclusion

TES is safe, economical and effective in treating DRA after delivery.

Key words: Diastasis rectus abdominis (DRA), Totally extraperitoneal sublay (TES), Laparoscope, Herniorrhaphy, Mesh
图1 经腹直肌入路完全腹腔镜下腹直肌后修补术操步骤注：1A观察孔进入腹直肌间隙。1B建立第一第二操作孔。1C向下游离显露腹壁下血管。1D向下游离显露耻骨梳韧带。1E切开腹直肌后鞘内侧。1F分离下腹部剖宫产手术瘢痕。1G倒刺线缝合腹直肌及腹直肌后鞘。1H腹直肌及腹直肌鞘缝合完毕。1I缝合切开的两侧腹直肌后鞘。1J腹直肌后鞘缝合完毕。1K放置补片及安置引流管。1L手术结束。
图2 经腹白线入路完全腹腔镜下腹直肌后修补术操作步骤注：2A镜推法建立腹膜前间隙。2B建立第一操作孔继续拓展腹膜前间隙。2C切开右侧腹直肌后鞘内侧。2D拓展右侧腹直肌后间隙。2E切开左侧腹直肌后鞘内侧。2F拓展左侧腹直肌后间隙。2G向下游离腹直肌后间隙及腹膜前间隙。2H游离完毕。2I倒刺线缝合腹直肌及腹直肌鞘。2J缝合完毕。2K放置疝修补网片。2L手术结束。
[1]
Gluppe S, Engh ME, Kari B. What is the evidence for abdominal and pelvic floor muscle training to treat diastasis recti abdominis postpartum? A systematic review with meta-analysis[J]. Braz J Phys Ther, 2021, 25(6): 664-675.
[2]
Michalska A, Rokita W, Wolder D, et al. Diastasis recti abdominis-A review of treatment methods[J]. Ginekol Pol, 2018, 89(2): 97-101.
[3]
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.
[4]
范国勇, 雷秋成, 姚干, 等. 腹腔镜肌后间隙修补腹直肌分离17例临床分析[J]. 中国实用外科杂志, 2023, 43(7): 803-806, 810.
[5]
Hu J, Gu J, Yu Z, et al. Efficacy of Standardized Rehabilitation in the Treatment of Diastasis Rectus Abdominis in Postpartum Women[J]. Int J Gen Med, 2021, 14: 10373-10383.
[6]
陈杰, 靳翠红, 申英末. 腹直肌分离的诊断与治疗[J]. 中华消化外科杂志, 2021, 20(7): 764-768.
[7]
Cavalli M, Aiolfi A, Bruni PG, et al. Prevalence and risk factors for diastasis recti abdominis: a review and proposal of a new anatomical variation[J]. Hernia, 2021, 25(4): 883-890.
[8]
Emanuelsson P, Gunnarsson U, Dahlstrand U, et al. Operative correction of abdominal rectus diastasis(ARD) reduces pain and improves abdominal wall muscle strength: A randomized, prospective trial comparing retromuscular mesh repair to double-row, self-retaining sutures[J]. Surgery, 2016, 160(5): 1367-1375.
[9]
封盼盼, 孙武东, 曲艺, 等. 产后腹直肌分离康复治疗研究进展[J]. 中国康复理论与实践, 2022, 28(9): 1065-1073.
[10]
Luque JB, Luque AB, Valdivia J, et al. Totally endoscopic surgery on diastasis recti associated with midline hernias. The advantages of a minimally invasive approach. Prospective cohort study[J]. Hernia, 2015, 19(3): 493-501.
[11]
Palanivelu C, Rangarajan M, Jategaonkar PA, et al. Laparoscopic repair of diastasis recti using the 'Venetian blinds' technique of plication with prosthetic reinforcement: a retrospective study[J]. Hernia, 2009, 13(3): 287-292.
[12]
黄永刚, 王平, 叶静, 等. 微小切口开放腹膜前手术在腹壁疝修补中的临床应用[J/OL]. 中华疝和腹壁外科杂志(电子版), 2019, 13(1): 21-26..
[13]
李光兴, 申英末. 腹直肌分离症的外科诊疗研究进展[J/OL]. 中华疝和腹壁外科杂志(电子版), 2021, 15(1): 4-7.
[14]
郑嘉明, 任苓, 张朋燕, 等. 腹直肌分离诊疗研究进展[J]. 赣南医学院学报, 2023, 43(3): 315-320.
[15]
乐飞, 郝晓辉, 李健文, 等. 腹腔镜辅助腹白线重建术治疗产后腹直肌分离的临床疗效[J]. 中华消化外科杂志, 2018, 17(11): 1122-1126.
[16]
Thabet AA, Alshehri MA. Efficacy of deep core stability exercise program in postpartum women with diastasis recti abdominis: a randomised controlled trial[J]. J Musculoskelet Neuronal Interact, 2019, 19(1): 62-68.
[17]
Nahas FX, Augusto SM, Ghelfond C. Nylon versus polydioxanone in the correction of rectus diastasis[J]. Plast Reconstr Surg, 2001, 107(3): 700-706.
[18]
Cheesborough JE, Dumanian GA. Simultaneous prosthetic mesh abdominal wall reconstruction with abdominoplasty for ventral hernia and severe rectus diastasis repairs[J]. Plast Reconstr Surg, 2015, 135(1): 268-276.
[19]
李炳根, 龚独辉, 缪锦超, 等. 完全腔镜下腹直肌后修补术治疗中线腹壁疝的新尝试[J]. 中华医学杂志, 2018, 98(36): 2933-2936.
[20]
唐健雄, 李绍杰. 不断推进中国腹腔镜疝手术规范化[J/OL]. 中华普外科手术学杂志(电子版), 2023, 17(6): 591-594.
[21]
徐飞, 张秀容, 周建平, 等. 腹膜外间隙空间的建立与细分在腹腔镜全腹膜外疝修补术中的应用研究[J/OL]. 中华普外科手术学杂志(电子版), 2021, 15(1): 80-83.
[22]
唐健雄, 李绍春, 李绍杰. 中国腹腔镜疝手术20年回顾与展望[J/OL]. 中华普外科手术学杂志(电子版), 2021, 15(6): 603-605.
[23]
Belyansky I, Daes J, Radu VG, et al. A novel approach using the enhanced-view totally extraperitoneal(eTEP) technique for laparoscopic retromuscular hernia repair[J]. Surg Endosc, 2017, 32(3): 1525-1532.
[24]
Li B, Qin C, Bittner R. Totally endoscopic sublay(TES) repair for midline ventral hernia: surgical technique and preliminary results[J]. Surg Endosc, 2018, 34(4): 1543-1550.
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