腹腔镜腹壁切口疝修补术25例报告

目的:探讨腹腔镜切口疝修补术的优缺点及手术技巧。方法:2011年7月至2013年2月为25例患者施行腹腔镜切口疝无张力修补术,其中20例行全腹腔镜腹壁切口疝修补术(全腹腔镜组),5例行杂交腹腔镜腹壁切口疝修补术(杂交组)。回顾分析两组患者手术方式、手术时间、术中出血量、术后住院时间、术后并发症等资料。结果:25例手术均获成功。全腹腔镜组手术时间平均(121.5±5.2)min,术中出血量平均(40±3.2)ml;患者均于术后第2天下床活动,2～3 d后进流质饮食,术后平均住院(5.35±0.29)d。杂交组手术时间平均(170±14.4)min,术中出血量平均(54±8.3)ml;术后第2天均下床活动,2～5 d进流质饮食,术后平均住院(10.4±1.84)d。术后患者均获随访,随访2～21个月,无一例复发;1例患者术后2个月出现低热、腹壁疼痛等症状,证实为腹壁腺癌,余者均无浆液肿、血肿、感染、肠漏及术后腹壁慢性疼痛等并发症发生。结论:腹腔镜腹壁切口疝修补术及腹腔镜-开腹杂交腹壁切口疝修补术是安全、可行的,手术方式及补片固定方式的选择应综合考虑患者病情及术者临床经验、手术技巧等因素,谨慎选择。

Laparoscopic tension-free hernioplasty for abdominal wall incisional hernia:a report of 25 cases

Objective:To investigate the advantages,disadvantages and surgical technique of laparoscopic hernioplasty.Methods:Laparoscopic tension-free hernioplasty was performed for 25 patients with abdominal incisional hernia from Jul.2011 to Feb.2013,among which 20 cases underwent laparoscopic hernioplasty(total laparoscopic group),the other 5 applied hybrid technique(hybrid group).The advantages and limitations of laparoscopic technique were discussed based on retrospective analysis of the clinical data,including operation methods,operation time,intraoperative blood loss,postoperative hospital stay,postoperative complications,etc.Results:All 25 operations were conducted successfully and patients recovered smoothly.For patients of total laparoscopy,mean operation time was(121.5±5.2) min,mean blood loss was(40±3.2) ml,out-of-bed activity occurred in the second day and liquid diet was taken 2 to 3 days after operation.Average postoperative hospital stay was(5.35±0.29) d.For patients of hybrid group,mean operation time was(170±14.4) min,mean blood loss was(54±8.3) ml.Patients got out-of-bed activity in the second day and had liquid diet 2 to 5 days after operation.Meanwhile the average postoperative hospital stay was(10.4±1.84) d.The 25 patients were followed up for 2 to 21 months and no recurrence occurred.1 case developed the symptoms of low fever and abdominal pain,which was confirmed to be postoperative recurrence of colon carcinoma and abdominal wall metastasis during return visit at 2 months after operation.The other 24 cases recovered with no complications such as seroma,hematoma,infection,intestinal fistula or chronic pain in the abdominal wall.Conclusions:Laparoscopic and laparoscopic-open hybrid tension-free hernioplasty for abdominal wall incisional hernia have been proved feasible and reliable.However,specific condition of patient,experience and skill of surgeon should be taken into serious consideration when it comes to the choice of operative mode and patch fixation method.