腹腔镜腹壁切口疝无张力修补术47例回顾

目的:探讨腹腔镜腹壁切口疝无张力修补术的手术方法及临床效果。方法:回顾分析2006年2月至2011年8月为47例患者行腹腔镜腹壁切口疝无张力修补术的临床资料。结果:41例(87.23%)顺利完成手术;6例中转开腹,其中2例小肠肠管破裂,1例腹腔内粘连广泛无法分离,3例肠管与腹壁及切口粘连致密无法分离。手术时间34～158 min,平均76 min。术后住院4～13 d,平均8.6 d。术后34例(72.34%)腹壁钉合区域腹壁疼痛,3例(6.38%)疼痛达2个月以上;14例(29.79%)发生浆液肿;无手术死亡、切口感染、补片感染及肠漏发生。随访8～46个月,平均13个月,无一例复发。结论:腹腔镜下松解腹腔内粘连,采用钉合器或钉合器加缝线贯穿腹壁双重固定补片法修补腹壁切口疝安全、有效,腹腔粘连严重分离困难的患者应及时中转开腹。

Laparoscopic tension-free hernioplasty for abdominal wall incisional hernia:a review of 47 cases

Objective:To investigate the surgical procedures and clinical effect of laparoscopic tension-free hernioplasty for abdominal wall incisional hernia.Methods:The clinical data of 47 patients with abdominal incisional hernia who underwent laparoscopic tension-free hernioplasty from Feb.2006 to Aug.2011 were analyzed retrospectively.Results:The operation of 41 patients(87.23%) were conducted successfully,while 6 cases were converted to open surgery because of rupture of small intestine(2 cases),extensively intraperitoneal adhesion(1 case)and dense adhesion between bowel and incision(3 cases).The operation duration was 34-158 min(average 76 min).Postoperative hospital stay was 4 to 13 d(average 8.6 d).Abdominal wall pain occurred in 34 patients(72.34%),and that of 3 patients(6.38%) lasted more than two months,seroma occurred in 14 patients(29.79%).No death,intestinal fistula,incision or mesh infection occurred postoperatively.No recurrence occurred after 8 to 46 months’(average 13 months) follow-up.Conclusions:Laparoscopic repair of abdominal wall incisional hernia after complete dissection of adhesion and fixation with stapler and suture is safe and effective.If extensive dense adhesion interferes dissection,convertion to open surgery should be taken.