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...     

腹腔镜下腹壁切口疝修补术

目的探讨腹腔镜下应用补片行腹壁切口疝修补术的方法、安全性及临床效果。方法2004年9月至2007年6月对56例切口疝（腹壁缺损长径7～19cm,宽径4～12cm）的患者行腹腔镜下应用补片行切口疝修补术。结果55例腹腔镜下行腹腔粘连松解和补片固定,顺利完成切口疝修补手术,1例因肠管与腹壁粘连紧密而中转开腹修补术。手术时间60～135min,平均92min。肠功能恢复早,术后排便、排气时间平均为31h,术后住院5～7d。术后并发症：术后疼痛达3个月以上者有9例,浆液肿8例。无手术死亡和肠瘘发生。随访16～28个月,平均19个月,未见切口疝复发。结论腹腔镜下行腹腔内粘连松解、采用缝合器和缝线贯穿腹壁固定补片来修补腹壁切口疝是一种安全、有效的微创方法,值得临床推广应用。     

开放式腹壁大切口疝和巨大切口疝补片修补术

目的探讨腹壁大切口疝和巨大切口疝治疗经验。方法对我院采用补片行开放式腹壁大切口疝和巨大切口疝修补术的51例患者临床资料进行回顾性分析。结果采用肌前补片修补法3例,肌肉间补片修补法3例,肌后腹膜前补片修补法39例,腹腔内补片修补法6例。手术时间109~195 min,平均135.2 min;术中出血15~90 ml,平均35.6 ml;术中无血管和内脏损伤等并发症。术后3~7 d(平均4.9 d)下床活动;住院时间7~19 d,平均9.7 d。2例患者术后出现浆液肿,经穿刺抽吸、负压吸引和腹带加压包扎后治愈。51例患者随访12~36个月(平均24.5个月),3例(5.9%)患者复发,后行开放式腹腔内补片修补手术,恢复良好,无再复发。所有病例无慢性疼痛。结论应用补片行开放式腹壁大切口疝和巨大切口疝修补术是一种安全、可靠的方法,复发率低。     

腹腔镜下腹壁巨大切口疝修补术的临床分析

目的 探讨腹腔镜下应用补片修补腹壁切口疝的手术方法及临床效果.方法 回顾性分析41例腹壁切口疝行腹腔镜下补片修补术患者的临床资料.结果 38例均顺利完成手术, 3例中转开腹.手术时间 78～186 min,平均 95 min.术后疼痛轻微,术后排便、排气时间 25～41 h,平均 32 h.术后第 2 d进食.术后住院 5～7 d,平均 6 d.41例随访 6～16个月,平均 9个月,未见疝复发.结论 腹腔镜下采用复合补片修补腹壁切口疝是一种安全、有效的方法,值得临床推广应用.     

腹腔镜下腹壁巨大切口疝修补术的临床应用

目的探讨腹腔镜下应用补片修补巨大腹壁切口疝的手术方法及临床效果。方法分析25例应用腹腔镜下补片修补腹壁巨大切口疝(腹壁缺损长径为12~25cm,宽9~18cm,缺损面积108~451cm2)患者的临床资料。结果21例(84.0%)顺利完成腹腔镜下腹壁切口疝修补术,4例(16.0%)因肠管与腹壁粘连紧密而中转开腹。手术时间78~186(平均95)min。术后住院5~8d,平均6.5d。术后疼痛达3个月以上8例(32.0%),经治疗后缓解;浆液肿9例(36%)。无切口感染和肠瘘发生;无手术死亡。全组患者随访6~25(平均11)个月,无切口疝复发。结论腹腔镜下修补腹壁巨大切口疝是一种安全、有效的方法,对腹腔粘连重分离困难者应及时中转开腹。     

老年腹壁切口疝的腹腔镜下修补术

目的 探讨腹腔镜下应用补片行老年腹壁切口疝修补术的方法、安全性及临床效果。方法 2004年11月至2006年6月对17例老年切口疝患者行腹腔镜下应用补片切口疝修补术。结果 16例腹腔镜下行腹腔粘连松解和补片固定,顺利完成切口疝修补手术,1例因肠管与腹壁粘连紧密而中转开腹修补术。手术时间65～132min,平均95min。术后恢复排便、排气时间平均为31h,术后住院5～7d。术后并发症：疼痛3个月以上者3例,浆液肿5例,穿刺口感染1例,均经保守治疗后好转,无手术死亡和肠瘘发生。随访7～26个月（平均13个月）,未见切口疝复发。结论 腹腔镜下行腹腔内粘连松解,采用缝合器和缝线贯穿腹壁固定补片修补老年腹壁切口疝安全、有效。     

小切口辅助腹腔镜巨大腹壁切口疝修补术的探讨

目的总结小切口辅助腹腔镜巨大切口疝修补术的经验。方法 2008年6月-2009年12月,采用小切口辅助腹腔镜修补巨大切口疝15例,疝环（12.3±3.4）cm,采用小切口切除疝囊并进行腹壁塑形。结果 15例均顺利完成手术,手术时间100-150 min,（123.3±15.9）min。小切口长度5-8 cm,（6.0±0.9）cm。术中发现隐匿疝6例,一并予以修补。浆液肿1例。术后住院时间4-8 d,（5.3±1.2）d。1例术后疼痛持续〉3个月,无切口感染和肠道及腹腔脏器损伤。全组随访12-30个月,（19.9±4.7）月,无复发。结论小切口辅助腹腔镜修补巨大切口疝是一种安全可靠的手术方法,术后并发症少,达到了腹壁塑形的效果。     

腹腔镜巨大切口疝修补术47例

目的探讨腹腔镜巨大切口疝修补术的治疗效果和技术要点。方法回顾性总结2004年3月至2009年6月间在我院进行的47例腹腔镜巨大切口疝修补术患者的资料,并对治疗效果和手术要点进行分析。结果术中2例（4.3%）患者因腹腔严重粘连中转开腹手术,其他患者均在腹腔镜下完成手术,肠管浆膜层损伤2例（4.3%）,手术时间平均为87±25min（56～145min）,无大出血病例。术后2例（4.3%）患者出现复发,1例进行了再次手术;34例患者（72.3%）有不同程度的术区腹壁疼痛,7例（14.9%）患者出现了不同程度的腹胀,但1～3个月后自行好转;2例（4.3%）患者术后出现了呼吸功能不全,经呼吸支持治疗后好转,2例（4.3%）患者出现了较明显的血清肿,经穿刺抽吸后好转。无术后出血、肠瘘或死亡病例。结论腹腔镜巨大切口疝修补术是安全、有效的术式。术中缝合、缩小疝环可以达到更加理想的治疗效果。     

腹壁切口疝的微创修补术

<正>腹壁切口疝是开腹手术后的常见并发症,发生率为10%～20%[1]。外科手术是治愈的唯一手段。应用人工合成修补材料是外科治疗切口疝新的里程碑,相对于组织修补术、补片修补术有较大的优势,如复发率下降、巨大切口疝得到治疗等。1993年     

Experience of Laparoscopic Incisional Hernia Repair in Kidney and/or Pancreas Transplant Recipients

Despite the wide popularity of laparoscopic incisional hernia repair (LIHR) in the nontransplant population, there are very few reports of LIHR available in abdominal organ transplant patients and none exclusively on kidney and/or pancreas (KP) transplant patients. We retrospectively reviewed a consecutive series of LIHR in KP transplant recipients performed over a period of 4 years and compared the results with LIHR in non‐transplant patients during the same period. A total of 36 transplant patients were compared with 62 nontransplant patients. There were five patients converted to the open procedure in the transplant and four in nontransplant patients (p‐NS). There were three seromas and one patient had a bowel perforation in the transplant group versus eight seromas, one bowel perforation and one small bowel obstruction noted in the nontransplant group. One patient in each group had a mesh infection requiring explant. Patients were followed up for a mean period of 2.2 years in the transplant group and 3 years in the nontransplant group. Overall there were five recurrences in the transplant group and four in the nontransplant group (p = NS). These results suggest that that LIHR is a safe and effective alternative to open repair.     

单孔腹腔镜腹壁切口疝无张力修补术

目的 探讨应用单孔腹腔镜器械行腹壁切口疝无张力疝修补的可行性及治疗效果.方法 对1例二次腹部术后出现腹壁切口疝的女性病人,应用单孔腹腔镜器械行无张力疝修补.患者取仰卧位,全身麻醉,于左腋前线平脐平面建立长约2.5 cm横行切口,放置Tri-port,电刀分离粘连,将补片通过Tri-port放入腹腔,通过钩针及螺旋钉枪(Protack)将补片固定在腹壁上. 结果 手术时间90 min,术中出血量＜10ml,术后住院时间7d.术后1月复查切口愈合好,疝无复发. 结论 应用单孔腹腔镜器械行腹壁切口疝无张力疝修补安全可行,手术时间与传统腹腔镜时间无明显差别,但其更具微创美容效果.     

Long-Term Study of Port-Site Incisional Hernia After Laparoscopic Procedures

Background:

Laparoscopic surgery is widely practiced and offers realistic benefits over conventional surgery. There is considerable variation in results between surgeons, concerning port-site complications. The aim of this study was to evaluate the laparoscopic port closure technique and to explore the factors associated with port-site incisional hernia.

Methods:

Between January 2000 and January 2007, 5541 laparoscopic operations were performed by a single consultant surgeon for different indications. The ports were closed by the classical method using a J-shaped needle after release of pneumoperitoneum. The incidence of port-site incisional hernias was calculated. All patients were followed up by outpatient clinic visits and by their general practitioners.

Results:

During a 6-year period, 5541 laparoscopic operations were performed. Eight patients (0.14%) developed port-site hernia during a mean follow-up period of 43 months (range, 25 to 96) and required elective surgery to repair their hernias. No major complications or mortality was reported.

Conclusion:

Laparoscopic port closure using the classical method was associated with an acceptable incidence of port-site hernia. Modification of the current methods of closure may lead to a new technique to prevent or reduce the incidence of port-site incisional hernias.     

疝环充填式无张力疝修补术治疗腹股沟疝的临床价值

目的总结疝环充填式无张力疝修补术治疗腹股沟疝的临床经验。方法 85例腹股沟疝使用网塞及网片行无张力修补。结果本组手术时间平均52（35-70）min。所有患者均于术后8 h进食和离床活动,3周后恢复正常工作,均未使用镇痛药。术后阴囊积液1例,尿潴留7例,经对症处理后恢复。随访3-38月无复发。结论本手术术后疼痛轻、恢复快、方法简便、适应证广、并发症少,复发率低,更符合疝发生的病理生理特点及腹股沟管的解剖结构,尤其适于在基层医院推广。     

针刺治疗对腹壁巨大疝术后患者胃肠功能的临床观察

目的:观察针刺对于腹壁巨大疝手术后患者胃肠功能恢复的临床疗效。方法:选取2015年1月—2017年12月我院收治的行巨大腹壁疝手术的患者90例,随机分为对照组和研究组,每组各45例。对照组行常规治疗,研究组在常规治疗的基础上加用针刺足三里、内关、上巨虚、公孙穴位治疗,比较两组术后肠道功能恢复效果、并发症发生情况及临床疗效。结果:研究组排气时间、首次排便时间、肠鸣音恢复时间及住院时间均明显低于对照组,差异有统计学意义(P<0.001)。术后第1天,两组腹胀、胃肠反应分级、腹痛评分比较差异无统计学意义(P>0.05),术后第5天,研究组的腹胀、胃肠反应分级、腹痛评分均低于对照组,差异有统计学意义(P<0.001)。研究组并发症发生率为6.66%,显著低于对照组(20.00%),差异有统计学意义(P<0.01)。研究组的总有效率为97.78%,显著优于对照组(71.11%),差异有统计学意义(P<0.05)。结论:针刺对于腹壁巨大疝术后胃肠功能恢复具有显著作用,且能减少并发症,安全性较好。     

Comparison of Prosthetic Materials in Incisional Hernia Repair

Purpose Incisional hernias are not uncommon after abdominal surgery, but their repair is associated with a high risk of complications, including adhesions and recurrence. Many different types of meshes and adhesion barriers have been developed in an attempt to overcome these problems, some of which we have assessed in a rat model.Methods We made a full-thickness 1.5 × 2.5-cm abdominal wall defect in 30 Sprague-Dawley rats, which were divided into three groups according to the materials used for repair: 2 × 3-cm polypropylene mesh (group 1); expanded polytetrafluoroethylene (PTFE) with double-layer polypropylene mesh (group 2); or polypropylene mesh with oxidized cellulose adhesion barriers (group 3). We assessed adhesion formation, tensile strength, and histopathologic findings.Results The mean adhesion scores were 3.3, 1.3, and 0.7, in groups 1, 2, and 3, respectively (P < 0.001). The area involved by adhesions was significantly greater in group 1 than in groups 2 or 3 (P < 0.01, P < 0.05), but there was no significant difference between groups 2 and 3 (P < 0.05). The tensile strength in group 2 was less than that in groups 1 or 3 (P < 0.01, P < 0.05), but there was no significant difference between groups 1 and 3 (P > 0.05).Conclusion Although there was less adhesion formation with PTFE and oxidized cellulose, PTFE not only impaired the tensile strength, but also induced fibrosis and inflammation. An oxidized cellulose adhesion barrier can be safely used in incisional hernia repair to prevent intra-abdominal adhesions.     

Laparoscopic Intraperitoneal Repair of Incisional and Ventral Hernias

Background : After reports in the literature on the safety and feasibility of laparoscopic repair of ventral hernia, and with the potential advantages of the minimal invasive approach, we started to perform this technique in 2001. This study was done to evaluate the results of our initial experience.

Methods : From March 2001 to October 2003, all patients with a ventral hernia greater than 4 cm were planned to have a laparoscopic repair. Patients were studied retrospectively, collecting data on preoperative and intraoperative variables, complications and recurrences.

Results : In 49 patients, out of 52 patients planned, laparoscopic repair was performed. The indication was incisional hernia in 88% and recurrence after open hernia repair in 43%. The mean hernia surface area was 86,6 cm² and 43% had a width greater than 10 cm. There were no intraoperative complications and the mean operating time was 103 min. Postoperative complications were seen in 9 patients (18,4%). Mean hospital stay was 5,9 days. Mean follow-up was 14,3 months. Late complications were seen in three patients (6,1%). Recurrence was present in one patient (2,0%). Conclusions : Laparoscopic repair of incisional and ventral hernia is a safe alternative for open mesh repair. Further definition of indications is needed, based on the dimension and the localization of the hernia. If the omission of transabdominal wall sutures improves the postoperative course with no adverse effect on recurrence rate, will be the subject of a randomized trial we have started this year.