腹壁切口疝修补术后腹壁膨出相关因素研究

目的探讨腹壁切口疝术后腹壁膨出（bulging）及复发的发生率及其相关危险因素。 方法回顾性分析2008年1月至2017年12月,复旦大学附属华东医院行腹壁切口疝修补术治疗的774例患者临床资料,观察腹壁膨出及疝复发的发生率与临床病例因素的关系。 结果术后平均住院时间（8.15±2.60）d,随访时间3～78个月。术后腹壁膨出58例（7.49%）,患者体质量指数（BMI）、是否急诊手术、是否使用补片、补片放置层次、手术入路、是否关闭腹壁缺损等与腹壁切口疝修补术后腹壁膨出有关。 结论影响腹壁切口疝术后腹壁膨出发生的独立危险因素为BMI、是否急诊手术、是否使用补片、补片放置的层次、手术入路、是否关闭腹壁缺损。临床应加强术前病例的筛选,减少急诊手术的同时,严格控制患者体重,选择合适的手术方式和植入修补、确实关闭腹壁缺损,并加强术后切口管理,以预防和减少腹壁切口疝术后腹壁膨出的发生。     

腹壁切口疝的微创外科治疗

<正>腹腔镜切口疝修补术(laparoscopic ventral hernia repair,LVHR)于1993年由LeBlanc等[1]首次报道,其为腹腔内修补法,是一种"后入路"的修补方式,复发率为2%～5%[2]。腹壁     

腹壁巨大切口疝术前评估及准备

腹壁切口疝是腹部手术后的远期并发症之一,其发生率约为2%～11%,若切口感染疝的发生率可增加至23%[1]。目前,美国1年的切口疝修补手术为20万例左右[2],年龄>65岁的老年病人尤为突出,约占39%[3]。近年来,随着人工合     

腹腔镜修补多发性腹壁切口疝

目的 探讨腹腔镜修补多发腹壁切口疝的手术方法和应用价值。方法 2008年2月首都医科大学宣武医院普外科收治1例腹部三次手术后共造成腹部四处切口疝的复杂病例,切口疝长径分别为12、9、6及3cm。采用疝修补缝合钉固定腹腔内大面积复合补片,行腹腔镜修补术。结果 腹腔镜一次修补4个腹壁切口疝手术成功,无肠管损伤等并发症,术后随访6个月无腹壁切口疝复发。结论 腹腔镜多发腹壁切口疝修补术安全、有效。在开腹手术中暴露多个缺损的难点,在腹腔镜手术中难度大大降低。腹腔镜多发腹壁切口疝修补术不但具有微创优势,而且更能发挥其技术优势。     

自体疝囊瓣修补腹壁巨大切口疝

自体疝囊瓣修补腹壁巨大切口疝耿协强樊献军李元地谭建美我院自１９９０年１０月～１９９６年１月收治１２例腹壁切口疝，其中３例巨大切口疝采用自体疝囊瓣修补成功，报告如下。１病例报告例１，女，４７岁。１９９０年５月因腹痛３天行剖腹探查，阑尾切除，术后切口感染...     

腹壁切口疝的诊治进展

目的 报道腹壁切口疝的诊治进展。方法 采用文献回顾的方法，对国内、外腹壁切口疝的病因、病理、临床流行病学资料以及诊断和治疗进展加以综述。结果 腹壁切口疝是腹部手术较为常见的并发症，严重影响患者生活质量，致病因素多样，治疗较为复杂。结论 腹壁切口疝重在预防，人工合成材料无张力修补是目前应用广泛、效果良好的治疗手段。     

腹腔镜手术治疗腹壁切口疝现状和趋势

腹壁切口疝是腹部手术后常见的医源性并发症之一,发病率约为3%～29%[1]。切口疝不能自愈,均需要手术治疗。手术方法有单纯缝合修补和无张力修补两种,随着腔镜技术的发展,这两种术式均能在腹腔镜下完成。腹腔镜腹壁切口疝修补术(laparoscopic ventral/incisional hernia repair,LVHR)最早报道于1993年。本文就目前开展的现状以及一些热点问题进行讨论。     

腹壁切口疝外科治疗新进展

腹壁切口疝修补是普外科常见手术之一,近三十年来,由于修补技术的创新和材料学的发展,切口疝外科治疗已发生了革命性变化,而其中最令人瞩目的变化是合成材料补片和生物补片修补技术的广泛应用,已明显降低了腹壁切口疝的术后复发率,而近年来腹腔镜在修补中的应用更为切口疝的外科治疗增添了新的途径.本文就目前的新技术及新材料在腹壁切口疝应用情况作一介绍.     

自体腹壁皮条法修补巨大切口疝12例体会

我院于1990年9月至1993年1月应用自体腹壁皮条法修补巨大切口疝12例。本法取材方便,可靠省时,并发症少,报告如下。1 临床资料本组男8例,女4例。年龄46～65岁。疝的部位:     

腹腔镜腹壁切口疝修补术的现状和展望

开放腹膜前修补术（sublay）和腹腔镜腹腔内修补术（IPOM）是治疗腹壁切口疝的主要术式,各类腔镜非腹腔内修补术（MINIM）目前处于探索阶段,未来有较大的进展空间。IPOM和MINIM术式具有不同的修补理念、技术特点和适应人群,严格把握手术指证,可以最大程度体现各自的优势。现代疝外科更注重“微创”和“腹壁功能重建”,在修复腹壁缺损、恢复腹壁功能的同时,尽可能减少腹壁的过度分离。随着新材料的研发、新技术的探索和腔镜平台的升级换代,基于微创理念的腹腔切口疝修补术会拥有更广阔的前景。     

Current considerations in laparoscopic incisional and ventral herniorrhaphy.

Laparoscopic ventral and incisional herniorrhaphy is gaining popularity among both surgeons and patients. The key to the success of this procedure is avoidance of complications. In this article, important considerations in the preoperative, intraoperative, and postoperative aspects of this procedure are reviewed, with a particular focus on the repair of incisional defects. Surgical considerations to assist in the prevention of certain pitfalls associated with laparoscopic repair of ventral and incisional hernias are described.     

无张力修补术在腹壁疝中的应用

目的探讨腹壁疝的无张力补片修补方法,总结腹壁疝的治疗经验。方法回顾性分析我科2004年10月至2008年11月间收治的25例腹壁疝患者的临床资料。24例手术采用全麻或硬膜外麻醉下的腹膜外补片无张力修补术。1例应用巴德CK补片,置于腹腔内。结果本组患者中,男性9例,女性16例;年龄37～81岁,平均年龄（68±10）岁。其中白线疝1例,半月环疝1例,脐疝6例,切口疝17例。腹壁切口疝疝环直径1～18cm,平均（7±4）em。均采用无张力疝修补术,平均手术时间（116±42）min。平均住院时间（8±3）d。术后1例发生轻微疼痛不适;术后2例发生浆液肿,经穿刺治愈;1例发生上呼吸道感染;随访6～48个月,无复发。结论采用人工补片行腹壁疝无张力修补术是一种安全可靠的手术方式,采用腹膜外修补方式进行手术,避免了补片与腹腔内脏器的直接接触,并发症少,复发率低。     

Operative treatment of ventral hernia using prosthetic materials

Objective The objective of this study was to summarize the clinical experiences in repairing abdominal incisional hernia with prosthetic materials. Methods Eighty-three patients with ventral hernia were analyzed retrospectively. Results Two patients developed pulmonary infection, one developed adhesive ileus, and five developed wound infection. All wounds healed completely during follow-up. Seventy-three (88%) patients were free of pain, and ten patients (12%) felt pain in the operated area within the last month; only one patient required pain-relieving drugs. Twenty-nine patients (35%) felt discomfort, such as stiffness. Four cases experienced postoperative recurrence. Conclusions Incisional herniorrhaphy with prosthetic materials is safe and effective but has a high discomfort rate. Open giant incisional hernia or recurrent incisional hernia should be performed by trained surgeons. Placing mesh in a suitable position and using a patch with minimal reaction and enough tensile strength may improve the prognosis. Further studies are necessary utilizing light polypropylene mesh.     

Evolution and advances in laparoscopic ventral and incisional hernia repair

Primary ventral hernias and ventral incisional hernias have been a challenge for surgeons throughout the ages. In the current era, incisional hernias have increased in prevalence due to the very high number of laparotomies performed in the 20 th century. Even though minimally invasive surgery and hernia repair have evolved rapidly, general surgeons have yet to develop the ideal, standardized method that adequately decreases common postoperative complications, such as wound failure, hernia recurrence and pain. The evolution of laparoscopy and ventral hernia repair will be reviewed, from the rectoscopy of the 4th century to the advent of laparoscopy, from suture repair to the evolution of mesh reinforcement. The nuances of minimally invasive ventral and incisional hernia repair will be summarized, from preoperative considerations to variations in intraoperative practice. New techniques have become increasingly popular, such as primary defect closure, retrorectus mesh placement, and concomitant component separation. The advent of robotics has made some of these repairs more feasible, but only time and well-designed clinical studies will tell if this will be a durable modality for ventral and incisional hernia repair.     

Emergent laparoscopic repair of incarcerated incisional and ventral hernia

Background The role of laparoscopy in the repair of incarcerated incisional or ventral hernia is not yet established. This presentation reviews the authors experience with patients who underwent laparoscopic surgery in presence of incarceration.Methods Patients who had surgery during the years 1997 to 2001 were included in the study. All patients underwent surgery immediately after their admission. In all cases, Gore-Tex Dual Mesh was used.Results The review included 25 patients (21 women and 4 men). Ten of these patients (40%) had undergone at least one earlier repair, and one patient (4%) underwent conversion to open repair because of small bowel injury. The mean operation time was 63 min (range, 15–20 min). The median postoperative hospital stay was 3.2 days (range, 2–7 days). There were no noteworthy postoperative complications. During the follow-up period, no patient experienced recurrent hernia.Conclusions The authors current has experience demonstrated that laparoscopic repair is feasible and can be attempted for patients presenting with incarcerated incisional or ventral hernia.     

Laparoscopic-assisted primary repair of a complicated ventral incisional hernia.

Postoperative wound dehiscence is a difficult problem for the general surgeon. Often, patients are too sick, or the wound environment is too hostile, to undergo primary repair. When an eventual repair is performed, a variety of methods are available, but most are associated with unacceptably high morbidity rates, specifically high incidences of recurrences and poor cosmetic outcome. We present here a case of postoperative wound dehiscence following a colostomy takedown repaired in a previously undescribed way--a laparoscopically assisted ventral incisional hernia repair. The method of repair is described, and the current literature regarding alternatives is reviewed.     

Laparoscopically assisted components separation technique for ventral incisional hernia repair

Reconstruction of the abdominal wall to repair ventral hernias continues to pose a challenge to surgeons due to relatively high rates of recurrence and morbidity. In 1990, Ramirez pioneered a technique of components separation of the abdominal wall for ventral hernia repair. Although an effective hernia repair, the mobilization of skin and subcutaneous tissue endangers the blood supply and predisposes midline skin to necrosis. The goal of this study is to determine whether releasing incisions in the transversus abdominis fascia and posterior rectus sheath provide adequate mobilization of the abdominal wall necessary for ventral hernia repair, thus paving the way for a laparoscopic component separation technique. Ten fresh cadavers were used and one side of the abdomen underwent the conventional Ramirez components separation: midline incision, dissection of skin and subcutaneous tissue off the anterior abdominal wall, and incisions in the external oblique aponeurosis and posterior rectus sheath, while the other side received incisions in the transversus abdominis fascia and the posterior rectus sheath with no undermining of the skin. The amount of fascial translation was measured after each incision. Incising only the external oblique aponeurosis produced greater mobilization of the abdominal wall at the level of the umbilicus (P = 0.02) and anterior superior iliac spine (ASIS, P = 0.029) than releasing only transversus abdominis fascia. More importantly, there was no statistically significant difference in the amount of release produced by the complete internal-release components separation versus the conventional technique. In order to test the feasibility of performing the procedure laparoscopically, one additional cadaver underwent a laparoscopic transversus abdominis fascia release. The procedure was successful and resulted in comparable amounts of fascial release as the other 10 cadavers. From this study, it appears technically feasible to perform a laparoscopic components separation to repair a ventral hernia and the procedure produces the same amount of release as the conventional open component separation technique.     

Laparoscopic ventral and incisional hernia repair: An 11-year experience

Incisional hernias develop in 2%–20% of laparotomy incisions, necessitating approximately 90,000 ventral hernia repairs per year. Although a common general surgical problem, a "best" method for repair has yet to be identified, as evidenced by documented recurrence rates of 25%–52% with primary open repair. The aim of this study was to evaluate the efficacy and safety of laparoscopic ventral and incisional herniorrhaphy. From February 1991 through November 2002, a total of 384 patients were treated by laparoscopic technique for primary and recurrent umbilical hernias, ventral incisional hernias, and spigelian hernias. The technique was essentially the same for each procedure and involved lysis of adhesions, reduction of hernia contents, closure of the defect, and 3–5 cm circumferential mesh coverage of all hernias. Of the 384 patients in our study group, there were 212 females and 172 males with a mean age of 58.3 years (range 27–100 years). Ninety-six percent of the hernia repairs were completed laparoscopically. Mean operating time was 68 min (range 14–405 min), and estimated average blood loss was 25 mL (range 10–200 mL). The mean postoperative hospital stay was 2.9 days and ranged from same-day discharge to 36 days. The overall postoperative complication rate was 10.1%. There have been 11 recurrences (2.9%) during a mean follow-up time of 47.1 months (range 1–141 months). Laparoscopic ventral and incisional hernia repair, based on the Rives-Stoppa technique, is a safe, feasible, and effective alternative to open techniques. More long-term follow-up is still required to further evaluate the true effectiveness of this operation.     

Feasibility and outcome after laparoscopic ventral hernia repair using Proceed mesh

Background  There are many different meshes available for laparoscopic repair of ventral hernias. A relatively new product is the Proceed mesh with a bioresorbable layer against the bowels and a polypropylene layer against the abdominal wall. There are, however, no human data available. The aim of this study was to evaluate the feasibility and outcome after laparoscopic ventral hernia repair using the Proceed mesh in humans. Methods  Patients presenting for laparoscopic ventral hernia repair in our department from September 2004 to October 2006 were included in the study. All patients had a standard laparoscopic ventral hernia repair using the Proceed mesh secured with tackers with a double crown technique. Patients were discharged according to standard discharge criteria, and follow-up was performed with a search in the national patient database and with manual search in the patients’ files. Results  Our study included 49 patients with a median age of 64 years (range 30–89) and body mass index of 27.8 (19.4–50.5). The dimensions of the mesh varied from 4 × 4 cm to 30 × 40 cm (median 15 × 15 cm). One patient developed an uncomplicated wound infection and none of the 49 patients developed mesh infections or postoperative seroma requiring surgical intervention. Thus, there were no mesh-related complications. During the follow-up period of 17 months (3–27), we have not seen any postoperative recurrences. The median length of stay was 1 day (range 0–63), and there was no mortality. Conclusion  Laparoscopic ventral hernia repair in humans using the Proceed mesh is feasible and has a low complication rate even in obese patients or those with pulmonary disease.     

开放式手术与腹腔镜手术治疗腹壁切口疝的对比研究

目的对比观察腹腔镜腹壁切口疝修补术与开放式切口疝修补术的疗效,以供临床参考。 方法总结2011年8月至2014年1月本院外科收治的52例腹壁切口疝患者临床资料,其中腹腔镜手术组28例,开放手术组24例。观察两组患者手术时间、住院时间、术中出血量、术区感染、术后疼痛的差异。 结果两组患者均顺利完成手术,与腹腔镜手术组对比,开放手术组在手术时间[(56.43±21.23) min vs (78.12±18.15) min, t=3.924, P<0.01]、住院时间[(5.12±1.18) d vs (7.25±2.45) d, t=4.085, P<0.01]、术中出血[(12.67±8.87) ml vs (135.18±56.78) ml, t=-6.927, P<0.01]、术后感染及疼痛等方面差异有统计学意义。 结论腹腔镜及开放式两种手术方式同样安全有效,腹腔镜手术在缩短住院时间,减少术中出血、术后疼痛方面占有明显优势。