生物补片修补食管裂孔疝的效果：1年随访

背景：尽管腹腔镜食管裂孔疝修补已取得良好的治疗效果,但对术中是否应该使用生物补片仍存在争议。目的：分析生物补片修补腹腔镜食管裂孔疝的效果。方法：回顾性分析2006-11/2009-06在复旦大学附属华山医院实施手术的57例食管裂孔疝患者临床资料,其中单纯膈肌脚缝合＋Nissen胃底折叠24例（对照组）,单纯膈肌脚缝合＋Nissen胃底折叠同时行补片加强33例（实验组）。对比分析使用补片和未使用补片的治疗结果。结果与结论：术后随访1年,实验组与对照组术后复发率、患者满意度、症状控制情况差异均无显著性意义（P〉0.05）。与对照组比较,实验组术中、术后并发症并未增加,同时手术时间及住院时间也未明显延长（P〉0.05）。短期随访结果说明补片加强修补食管裂孔疝是安全、有效的,但应严格掌握适应证。     

腹腔镜下应用补片治疗食管裂孔疝

目的探讨腹腔镜下应用补片治疗食管裂孔疝的临床效果及安全性。方法回顾性分析26例采用腹腔镜技术应用补片治疗食管裂孔疝患者的临床资料。结果所有患者手术均成功,无中转开腹手术及死亡病例。26例手术用时100～190 min,平均121 min;术中出血较少,无需输血。术后24 h可进食,住院5～9 d,期间所有患者未出现并发症。经过12个月的随访,未发现复发患者。结论腹腔镜下应用补片治疗食管裂孔疝创口小、安全性高、并发症出现几率低,值得临床推广应用。     

腹腔镜下应用复合补片行食管裂孔疝修补手术的配合

腹腔镜下应用复合补片行食管裂孔疝修补及胃底折叠抗反流术是一种新型的手术方式,对手术配合要求较高。术前了解病情和充分的器械准备是开展此项手术的前提。术中及时的器械传递和与术者良好配合是手术成功的关键。总结此项手术经验,以促进新技术、新业务的提高和应用。     

腹腔镜下应用补片治疗食管裂孔疝临床分析

目的探讨腹腔镜下补片植入术治疗食管裂孔疝的可行性及安全性。方法对我院21例食管裂孔疝患者施行腹腔镜补片植入术治疗。其中Ⅰ型14例（66．67％）,Ⅱ型5例（23．81％）,Ⅲ型2例（9．52％）。结果本组21例患者手术均获得成功。手术时间120～190min,失血40～130ml。术后食管反流症状均消失,无穿孔、出血等并发症发生。术后24～36h进流质饮食,逐渐过渡到普食,进食后无食物反流及胸骨后疼痛等症状发生。术后住院5～10d,平均8d。随访6个月至3年,症状完全消失,均无疝复发。结论应用腹腔镜下补片植入术治疗食管裂孔疗效确切、创伤小、痛苦少、恢复快,具有较大的临床实用价值。     

腹腔镜下应用复合补片行食管裂孔疝修补手术的配合

腹腔镜下应用复合补片行食管裂孔疝修补及胃底折叠抗反流术是一种新型的手术方式,对手术配合要求较高。术前了解病情和充分的器械准备是开展此项手术的前提。术中及时的器械传递和与术者良好配合是手术成功的关键。总结此项手术经验,以促进新技术、新业务的提高和应用。     

腹腔镜食管裂孔疝修补术(附15例报告)

目的 探讨腹腔镜食管裂孔疝修补术的疗效和安全性.方法 2006年9月至～2010年3月对15例食管裂孔疝患者行腹腔镜食管裂孔疝修补术,同期行部分胃底折叠术.结果 手术全部成功.手术时间90～120min,平均110min.出血量30～110mL,平均50mL.无胃食管穿孔、大出血、气胸及下肢深静脉血栓等并发痘.术后平均住院时间5.5 d.术后随访平均18个月,无疝复发病例.结论 腹腔镜食管裂孔疝修补术是一种安全有效的手术方法,具有很好的应用前景.     

腹腔镜食管裂孔疝修补术加用补片的临床疗效及预后分析

目的分析腹腔镜食管裂孔疝修补手术中加用补片的疗效及预后。方法将2014年10月—2019年1月东南大学附属中大医院收住的100例因胃食管反流病行腹腔镜食管裂孔疝修补术患者随机分为补片组和非补片组,患者均行经腹腔镜食管裂孔疝修补术加胃底折叠术(短松Nissen术式),其中补片组加用食管裂孔疝专用补片予以修补,非补片组不使用补片。对两组患者进行长期的术后随访调查,比较两组的手术疗效、术后并发症发生率、复发率、满意度等。结果 98例患者成功完成1年以上随访,其中补片组68例,非补片组30例。术后1年时,补片组与非补片组反流发作、烧心、吞咽困难和进食食物情况症状评分的改善比较,差异有统计学意义(P<0.05);补片组和非补片组患者满意度分别为82.4%和73.3%,差异无统计学意义(P>0.05);补片组与非补片组复发率分别为2.9%和26.7%,差异有统计学意义(P<0.05);补片组和非补片组吞咽困难发生率分别为47.0%和6.7%,差异有统计学意义(P<0.05)。结论针对食管裂孔疝所致的胃食管反流病患者,在合理选用食管裂孔疝专用补片的基础上,熟练掌握腹腔镜食管裂...     

腹腔镜下Nissen胃底折叠术联合食管裂孔疝修补术治疗食管裂孔疝的效果

目的 分析腹腔镜下Nissen胃底折叠术联合食管裂孔疝修补术治疗食管裂孔疝的效果.方法 选取2014年1月至2021年1月开封市人民医院收治的58例食管裂孔疝患者的临床资料,按照随机数字表法分为对照组与试验组,每组29例,对照组采用常规开腹手术,试验组采用腔镜下Nissen胃底折叠术联合食管裂孔疝修补术,比较两组围术期...     

经腹腔镜食管裂孔疝修补术的围手术期护理体会

食管裂孔疝也称膈肌裂孔疝,多见于45岁以上的患者,手术是根治食管裂孔疝的有效方法,传统的手术方法为经胸或经腹手术[1]。经胸手术切口大、心肺干扰重,只能完成修复食管裂孔。实施胃底折叠术对呼吸功能影响大,经腹手术操作十分困难。近年来,应用腹腔镜修补食管裂孔疝在欧美发达国家已被广泛运用,手术技术日益成熟。这一术式具     

预见性护理程序在腹腔镜下食管裂孔疝修补术后的运用价值

目的探讨术后预见性护理在腹腔镜下食管裂孔疝修补术患者中的运用价值。方法选择本院于2013年1月~2015年10月收治的食道裂孔疝患者共64例为研究对象。按照患者入院顺序号随机分为观察组与对照组各32例。对照组采用常规术后护理,观察组采用术后预见性护理程序。比较两组术后吞咽困难、腹胀、恶心呕吐、切口感染等并发症发生率。在患者出院时,采用自制的问卷进行术后并发症知识、自护能力与护理满意度评价。结果观察组术后发生吞咽困难1例、腹胀1例、恶心呕吐1例,未见切口感染患者,并发症总发生率为9.38%(3/32),显著低于对照组31.25%(10/32)的并发症总发生率(P0.05)。观察组术后健康知识、自护能力以及护理满意度评分分别为(88.53±7.25)分、(86.41±8.09)分、(90.24±6.42)分,均显著高于对照组(均P0.05)。结论为腹腔镜下食管裂孔疝修补术患者提供预见性护理,可以有效预防术后并发症,提高患者对并发症的认知以及护理满意度。     

Laparoscopic repair of voluminous symptomatic hiatal hernia using absorbable synthetic mesh

Introduction: Hiatal hernia is a common disorder and a controversial topic. In symptomatic voluminous hernias laparoscopic surgery and use of mesh can be considered. An initial experience in voluminous hiatal hernia laparoscopic repair using absorbable glycolic acid/trimethylene carbonate synthetic mesh is reported. Material and methods: Retrospective study from an institutional database was performed to analyze laparoscopic hiatal hernia repair using absorbable synthetic mesh from January 2010 to December 2013. All preoperative symptoms and exams were collected and a standardized procedure was performed. Clinical and radiological follow-up was performed. Results: Eight patients underwent laparoscopic repair of hiatal hernia performed by two highly skilled laparoscopic surgeons. One Toupet and seven Nissen fundoplications were tailored. No conversions into laparotomy, neither intraoperative complications nor mortality occurred. After a median follow-up of 23.5 months (range 14 - 44) no mesh complications occurred and all patients are asymptomatic. Two radiological recurrences (25%) were detected. Conclusions: Voluminous symptomatic hiatal hernias can be successfully treated in a high-volume and long-term experienced laparoscopic surgical center by the use of an absorbable synthetic mesh. Further studies and a longer-term follow-up are necessary to confirm this preliminary report.     

Deperitoneum biological mesh repair for abdominal wall hernia: a novel wound healing promotion idea

Purpose: Nowadays, biological matrix has become more widely applied than synthetic mesh for the surgical management of ventral hernia. Conventionally, such biodegradable matrix is commonly placed in an intraperitoneal or extraperitoneal position to reinforce the abdominal wall during surgery. Herein, we introduce our novel idea to deliver such biological material.

Material and methods: After contrast-enhanced CT-scan via lateral decubitus confirmed the position of ventral hernias, 11 patients underwent deperitoneum biological mesh repair by open or laparoscopic approach. During surgery, biological material was placed in preperitoneal position with elimination of matrix-covered peritoneum meanwhile. No bridge repair was allowed for this technique. Postoperative complications were prospectively documented.

Results: Laparoscopic and open repair were performed in six and five patients, respectively. The mean operative time was 115?min, with no significant difference between the two procedures. All patients had quick recovery and returned to their normal life, with median five days (range, 3-12 days) of hospital stay after surgery. Although wound dehiscence and chronic pain occurred in three (27.3%) patients, no additional surgery was required. No recurrence case was observed within the one-year follow-up period.

Conclusion: This novel approach could be safely performed in ventral hernia patients. Early evaluation of this surgical technique demonstrates quick recovery and minimal complications.     

疝环充填式无张力疝修补术治疗腹股沟疝临床分析

目的探讨疝环充填式无张力疝修补术在腹股沟疝治疗中的应用。方法用聚丙烯锥形疝环充填物及补片对67例腹股沟疝(含复发疝)患者行疝环充填式无张力疝修补术,对手术方法、术后患者活动时间、伤口疼痛、住院时间、并发症、复发情况进行观察。结果全组均痊愈,平均手术时间45 m in,无切口感染、血肿及阴囊积液,无复发病例。结论疝环充填式无张力疝修补术安全,创伤小,痛苦小,术后恢复快,复发率低,疗效满意,是治疗腹股沟疝的理想术式。     

Abdominal wall hernia mesh repair: sonography of mesh and common complications.

OBJECTIVE: The purposes of this study were (1) to review the sonographic in vitro and in vivo appearances of mesh for surgical repair of abdominal wall hernias, (2) to describe sonographic techniques and discuss the limitations of sonography in evaluation of mesh hernia repair, and (3) to illustrate common complications after mesh repair shown with sonography. METHODS: We identified interesting cases from the musculoskeletal sonographic database as well as from the teaching files of the authors, with surgical or other cross-sectional imaging corroboration. RESULTS: A compilation of the sonographic appearances of mesh used for anterior abdominal wall and inguinal hernia repair and complications diagnosable by sonography is presented. CONCLUSIONS: Sonography can be effective for evaluation of mesh and complications after mesh repair of anterior abdominal wall and inguinal hernias.     

Richter's hernia after an intraperitoneal mesh repair

For ventral hernia repair, laparoscopic surgery offers various advantages, including the application of a large mesh using the intraperitoneal approach. However, improper closure of the port site may lead to serious complications. Port‐site hernia is a rare outcome of inadequate repair of the fascial or peritoneal layer, and Richter's hernia in a high risk patient, in the presence of an intraperitoneal mesh, is a particularly challenging scenario. Herein, we present a 58‐year‐old woman who, after a ventral hernia repair, was diagnosed with a small bowel hernia through a 10‐mm port site. The patient complained of pain and mild swelling at the port site in the postoperative period, and her symptoms indicated intestinal obstruction. Clinical evaluation and abdominal X‐ray confirmed the diagnosis, and early laparoscopic re‐exploration and management were the key to a favorable outcome.     

腹腔镜网塞法腹股沟疝修补术术式探讨

目的 探讨一种新术式--腹腔镜下网塞法腹股沟疝修补术的临床应用价值.方法 在腹腔镜手术中利用"玫瑰花"补片网塞经腹腔内进行疝修补.将该科同时期施行的9例腹腔镜下网塞法腹股沟疝修补术与10例腹腔镜全腹膜外疝修补术(TEP)在疗效、复发率、并发症各方面进行比较.结果 所有病例均获术后治愈,在最长达19个月的随访时间内无复发.2例TEP术后有并发症发生,所有新术式患者无并发症发生.结论 腹腔镜下网塞法腹股沟疝修补术治疗腹股沟疝疗效确切,近期未观察到复发,尚未发现并发症,可进一步增加病例数并观察远期疗效,评估手术适应证.该术式有望成为一种新的腹腔镜腹股沟疝修补术式.     

双层立体补片与聚丙烯充填式网塞补片修补无张力腹股沟疝的效果比较

背景：应用补片行无张力腹股沟疝修补现已被广大临床外科医生所普遍认同,但补片类型很多,临床外科医生往往很难选择。目的：对比双层立体补片、聚丙烯充填式网塞补片修补腹股沟疝的疗效。方法：回顾性分析150例腹股沟疝患者的临床资料,其中男133例,女17例,年龄21—80岁,81例采用双层立体补片行无张力疝修补,69例采用聚丙烯充填式网塞补片行无张力腹股沟疝修补,均为首次接受手术治疗。总结两种治疗方式适应证,记录两组手术时间、下床活动时间、平均住院时间、术后局部疼痛及不适感和异物感情况,随访2年观察复发情况。结果与结论：疝环口大、腹横筋膜薄弱、腹股沟管后壁缺损适宜选择双层立体补片,而不宜选择聚丙烯充填式网塞补片。两组手术时间、下床活动时间及平均住院时间比较差异无显著性意义,但双层立体补片组术后局部疼痛、术后不适感和异物感及随访2年后复发率明显低于聚丙烯充填式网塞补片组（P〈0．05）。结果表明与聚丙烯充填式网塞补片相比,双层立体补片适应证广,组织相容性好,局部不适和异物感症状轻,疼痛发生率及复发率低,是更为理想的补片选择。     

Laparoscopic mesh repair of parahiatal hernia: A case report

We report a case of a primary parahiatal hernia that was repaired laparoscopically with a composite mesh. A 51‐year‐old woman presented with vomiting and epigastric pain. CT scan showed a giant paraesophageal hernia with intrathoracic gastric volvulus. Intraoperatively, a diaphragmatic muscular defect was found lateral to an attenuated left crus of the diaphragm, distinct from the normal esophageal hiatus. The defect ring was fibrotic, making a tension‐free primary repair difficult. A laparoscopic mesh repair was performed with a composite mesh, which was covered with the hernia sac to prevent potential erosion into the esophagus or stomach. Recovery was uneventful and the patient was discharged on the 5 days postoperatively. She remained asymptomatic at subsequent follow‐up. Laparoscopic repair of parahiatal hernia can be safely performed. In circumstances where a large or fibrotic defect prevents a tension‐free primary repair, the use of a composite mesh can provide effective repair of the hernia.