总结腹腔镜手术治疗膈疝的临床经验。

回顾性分析2022年1月至2024年10月于南京江北医院行腹腔镜手术治疗的10例膈疝患者的临床资料。手术要点：先回纳疝内容物，分离疝环与周围组织粘连，完整暴露疝环；接着探查胸腔，使用不可吸收缝线关闭疝环；测量疝环长度，放置防粘连补片超过薄弱区域至少3 cm；最后使用钉枪和缝线加固补片。术后门诊和电话随访患者恢复情况。

患者术前均行多学科讨论，其中2例患者营养风险筛查2002（NRS 2002）量表评分≥3分，予以营养支持。术中诊断左侧膈疝9例，右侧1例，常见疝内容物为胃（7例）、结肠（6例）和大网膜（5例）。膈肌缺损面积平均为（59.0±28.4）cm²，平均手术时间（124.5±35.9）min，中位术中出血25（20，50）ml，均保留疝囊。术后ICU呼吸支持4例，常见并发症为胸腔积液和肺部感染。患者均顺利出院，中位住院时间为11.5（9.3，19.0）d，中位随访时间为16.5（13.5，19.5）个月。随访期间，患者未出现膈疝复发等并发症。

腹腔镜膈疝修补手术具有探查仔细，副损伤少，安全可靠等优点。术前营养支持，多学科讨论，术中保留疝囊，加固补片，术后呼吸支持可能有利于患者恢复。

To summarize the clinical experience of laparoscopic surgical treatment for diaphragmatic hernia.

The clinical data of 10 patients with diaphragmatic hernia who underwent laparoscopic surgery at Nanjing Jiangbei Hospital between January 2022 and October 2024 were retrospectively analyzed. The key operative steps were as follows: first, reduction of the hernia contents was performed, and adhesions between the hernia ring and surrounding tissues were carefully dissected to achieve complete exposure of the defect; next, the thoracic cavity was explored, and the hernia ring was closed with non-absorbable sutures; the length of the hernia ring was then measured, and an anti-adhesion mesh was placed to overlap the weakened area by at least 3 cm; finally, the mesh was reinforced using a tacker and sutures. Postoperative recovery was assessed through outpatient visits and telephone follow-up.

All patients underwent preoperative multidisciplinary team discussion. Two patients had a Nutritional Risk Screening 2002 (NRS 2002) score ≥3 and received nutritional support. Intraoperatively, nine patients were diagnosed with left-sided diaphragmatic hernia and one with right-sided hernia. The most common hernia contents were the stomach (7 cases), colon (6 cases), and greater omentum (5 cases). The mean diaphragmatic defect area was (59.0±28.4) cm², the mean operative time was (124.5±35.9) minutes, and the median intraoperative blood loss was 25 (20, 50) ml. The hernia sac was preserved in all cases. Postoperatively, four patients required respiratory support in the intensive care unit. The most common complications were pleural effusion and pulmonary infection. All patients were discharged uneventfully. The median length of hospital stay was 11.5 (9.3, 19.0) days, and the median follow-up duration was 16.5 (13.5, 19.5) months. During follow-up, no recurrence of diaphragmatic hernia or other related complications was observed.

Laparoscopic diaphragmatic hernia repair has the advantages of thorough exploration, minimal collateral injury, and safety and reliability. Preoperative nutritional support, multidisciplinary discussion, intraoperative preservation of the hernia sac, reinforcement of the mesh, and postoperative respiratory support may contribute to improved patient recovery.