开放式腹腔内修补治疗腹壁切口疝

目前常用的开放式腹壁切口疝修补手术有：(1)肌鞘前修补方法，即用单纯聚丙烯材料在腹壁脂肪与肌鞘(如腹直肌鞘)之间进行修补；(2)肌肉与肌肉(如中线切口裂开)之间的修补方法，通常采用聚四氟乙烯材料直接与腹壁缺损的边缘进行缝合修补；(3)肌后和腹膜外修补方法，一般采用聚丙烯材料或聚丙烯与聚四氟乙烯复合材料，在腹直肌肌肉与后鞘之间或腹直肌与腹膜之间对缺损进行修补：     

腹腔镜腹腔内补片置入术在腹壁切口疝修补中的应用

目的探讨腹腔镜腹腔内补片置入术在腹壁切口疝修补中临床应用价值。方法腹腔镜经腹腔内使用膨化聚四氟乙烯双层补片治疗13例腹壁切口疝。结果13例手术均获成功,手术时间45—120min,平均73min,无手术死亡病例及并发症发生,患者术后8～24h后下床活动,1～2d排气,术后疼痛轻,2～3d后完全缓解,3～7d（平均4d）患者顺利康复出院。随访12～24个月无复发。结论腹腔镜腹壁切口疝修补术安全可靠,具有创伤小、术后康复快、并发症少、不增加手术穿刺孔、可完成联合手术等优点,临床应用前景广阔。     

剖腹腹腔内补片修补腹壁切口疝21例体会

目的 探讨、总结剖腹腹腔内补片修补腹壁切口疝的经验.方法 2007年2月至2010年3月收治的21例腹壁切口疝采用复合补片进行开放式完全腹腔内修补.结果 1例术后3d死于腹腔室间隔综合征,其余20例无并发症发生,随访 6个月～3年无复发.结论 腹壁切口疝采用复合补片进行开放式完全腹腔内修补方法安全、有效     

腹腔镜下腹腔内补片植入修补法治疗获得性腰疝的临床疗效

目的探讨腹腔镜下腹腔内补片植入修补法治疗获得性腰疝的临床疗效,为获得性腰疝的治疗提供相对合理的方案。 方法2015年1月至2018年6月,首都医科大学附属北京中医医院共对47例获得性腰疝的患者采用腹腔镜下腹腔内补片植入修补法进行治疗,记录患者手术前后的临床参数,观察并分析术后并发症及复发情况。 结果47例患者均经腹腔镜顺利完成手术,手术时间100～180 min,平均134 min;术中出血量80～140 ml,平均110 ml;术后住院时间5～14 d,平均7 d。术后出现浆液肿2例,经穿刺抽液后给予腹带包扎处理后治愈;腹胀4例,均于5 d内自行缓解;肠梗阻1例,于术后第13天治愈;术区疼痛不适10例,给予止痛药治疗后缓解;戳孔感染2例,给予积极换药处理后治愈;患者术后均未出现肠瘘、腹腔感染、戳孔血肿、戳孔疝、慢性疼痛等严重并发症。随访时间6～48个月,均未出现疝复发。 结论获得性腰疝修补采用腹腔镜下腹腔内补片植入修补法进行治疗,目前是一种有效且安全、可行的治疗方法,可促进患者快速康复,降低相关并发症的发生及疝的复发,值得临床进一步推广。     

腹腔镜下腹壁切口疝补片修补术

腹壁切口疝是开腹手术后的常见并发症。使用补片的手术修补是主要的治疗方法。相对于开放的补片修补术,腹腔镜下补片修补术具有创伤小,不适症状轻,术后恢复快及住院时间短,复发率更低等优点,为越来越多的临床医师接受和应用。然而随着手术病例的增加,也逐渐显现了一些问题,诸如复发、慢性疼痛、肠损伤、血清肿的发生,一些特殊部位的切口疝如何修补等。     

腹腔镜下腹腔内补片修补术治疗腹壁切口疝的临床研究

目的探讨腹腔镜下腹腔内补片修补术（IPOM）治疗腹壁切口疝的安全性及可行性。 方法回顾性分析2014-2019年中国人民解放军南部战区总医院对103例腹壁切口疝患者实施腹腔镜下IPOM的临床资料,观察其手术时间、术后排气时间、术后住院时间、并发症及复发情况。 结果103例患者均顺利完成手术,平均手术时间、术后排气时间及术后住院时间分别为（100±10）min、（40±8）h及（7.5±1.5）d。术中发现1例合并脐疝同时行脐疝修补,1例合并右侧腹股沟直疝同时行TAPP术,1例嵌顿性肠梗阻并肠坏死同时行肠切除吻合术。术后轻微并发症经短期治疗后痊愈,随访3~24个月,均无切口疝复发。 结论腹腔镜下IPOM治疗腹壁切口疝具有安全、有效、创伤小、可发现隐匿疝、术后康复快、能降低并发症、缩短住院时间、复发率低等优点。     

腹腔镜完全腹膜外补片修补与腹腔镜腹腔内补片修补治疗两侧下腹壁切口疝的临床疗效比较

目的 比较腹腔镜完全腹膜外补片修补术(totally extraperitoneal sublay,TES)与腹腔镜腹腔内补片修补术(intraperitoneal onlay mesh,IPOM)治疗两侧下腹壁切口疝的临床疗效.方法 选取2017年5月～2020年5月我院两侧下腹壁切口疝41例,随机分为2组:IPOM...     

腹腔镜下腹壁切口疝补片修补的相关问题

腹部切口疝一直是外科剖腹手术后常见的并发症，在剖腹手术后的发生率为3％～13％，感染性伤口的切口疝发生率。切口疝早期的手术方法是行单纯缝合，术后复发率为20％～52％，复发率高的主要原因是修补后张力高。随后出现了人工编织物的无张力修补．术后复发率降至11％左右。但是由于要分离出一个容纳补片的间隙，所以必须对腹壁组织进行较大的解剖和分离．这就造成了大面积的腹壁组织损伤，也造成了术后病人比较剧烈的疼痛．     

腹壁切口疝腹腔镜腹腔内补片置入术临床价值研究

目的 探讨腹壁切口疝腹腔镜腹腔内补片置入术(IPOM)的临床应用价值.方法 回顾性分析2015-01—2019-12睢县人民医院行修补术治疗的80例腹壁切口疝患者的临床资料.按修补手术方法分为腹腔镜腹腔内补片置入术组(腹腔镜IPOM组)与开放腹膜前间隙补片置入术组(开放Sublay组),各40例.比较2组患者的基线资料...     

比较腹腔镜腹腔内与开放腹膜前间隙补片置入术治疗腹壁切口疝的效果

目的比较腹腔镜腹腔内补片置入术(IPOM)与开放腹膜前间隙补片置入术(Sublay)治疗腹壁切口疝的效果。方法选取2016-01—2019-01间在郑州大学第一附属医院接受疝修补术治疗的76例腹壁切口疝患者,将36例行腹腔镜IPOM术的患者作为腔镜组。将40例行开放Sublay术的患者作为开放组。回顾性分析患者的临床资料。结果2组患者均成功完成手术。2组手术时间差异无统计学意义(P>0.05)。腔镜组术中出血量、术后肠蠕动恢复时间及住院时间均少于开放组,差异有统计学意义(P<0.05)。腔镜组术后近期疼痛发生率低于开放组,差异有统计学意义(P<0.05),其余并发症差异无统计学意义(P>0.05)。结论腹腔镜IPOM术具有创伤小、恢复快、疼痛轻、出血少、并发症少等优点,具有更广阔的应用前景。     

Results of laparoscopic versus open abdominal and incisional hernia repair.

BACKGROUND: Incisional hernia is a frequent complication of abdominal surgery. The object of this study was to confirm the safety, efficacy, and feasibility of laparoscopic treatment of abdominal wall defects. METHODS: Fifty consecutive laparoscopic abdominal and incisional hernia repairs from September 2001 to May 2003 were compared with 50 open anterior repairs. RESULTS: The 2 groups were not different for age, body mass index, or American Society of Anaesthesiologists scores. Mean operative time was 59 minutes for the laparoscopic group, 164.5 minutes for the open group. Mean hernia diameter was 10.6 cm for the laparoscopic group, 10.5 cm for the open group. Mean length of stay was 2.1 days for the laparoscopic group, 8.1 days for the open group. Complications occurred in 16% of the laparoscopic and 50% of open group. Median follow-up was 9.0 months for the laparoscopic group, 24.5 months for the open group. Recurrence rates were 2% for laparoscopic group and 0% for the open group. CONCLUSION: Results for laparoscopic abdominal and incisional hernia repair seem to be superior to results for open repair in terms of operative time, length of stay, wound infection, major complications, and overall hospital reimbursement.     

Laparoscopic versus open incisional hernia repair

Background Incisional hernia is a common complication of abdominal surgery, and it is often a source of morbidity and high costs for health care. This is a case-control study to compare laparoscopic versus anterior-open incisional hernia repair. Methods 170 patients with incisional hernia were enrolled in this study between September 2001 and December 2004. Of these, 85 underwent anterior-open repair (open group: OG), and 85 underwent laparoscopic repair (laparoscopic group: LG). The clinical outcome was determined by a median follow-up of 24.0 months for LG and OG. Results No difference was noticed between the two groups in age, American Society of Anesthesiologists (ASA) score, body mass index (BMI), and incisional hernia diameter. Mean operative time was 61.0 min for LG patients and 150.9 min for OG patients (p < .05). Mean hospitalization was 2.7 days for LG patients and 9.9 days for OG patients (p < .05). Mean return to work was 13 days (range, 6–15 days) in LG patients and 25 days (range, 16–30 days) in OG patients. Complications occurred in 16.4 % of LG patients and 29.4 % of OG patients, with a relapse rate of 2.3% in LG and 1.1% in OG patients. Conclusions Short-term results indicate that laparoscopic incisional hernia repair is associated with a shorter operative time and hospitalization, a faster return to work, and a lower incidence of wound infections and major complications compared to the anterior-open procedure. Further studies and longer follow-up are required to confirm these findings.     

腹腔镜与开放式巨大腹壁切口疝补片修补术的对比分析

目的:比较开放手术及腹腔镜补片修补巨大腹壁切口疝的手术效果。方法:回顾分析我院2003年1月至2007年6月收治的43例巨大腹壁切口疝患者的临床资料。根据手术方式分为腹腔镜组(16例)和开放组(27例),对两组手术时间、术后并发症、术后住院时间等进行对比分析。结果:两组手术时间、术后并发症发生率无明显差异。开放手术组2例发生切口感染,1例经冲洗引流2个月治愈,另1例再次手术取出补片。腹腔镜手术组术后住院时间和手术出血量明显少于开放手术组。术后随访4~48个月,平均21个月,两组均无复发病例。结论:腹腔镜下应用补片修补巨大腹壁切口疝同样安全、合理,且具有患者创伤小、康复快和术后住院时间短等优点。     

Laparoscopic mesh repair of incisional hernia: an alternative to the conventional open repair?

Background Tension-free incisional hernia repair using alloplastic material increasingly replaces conventional repair techniques. This change resulted in a decreased recurrence rate (50% vs. 10%, respectively). Recently, laparoscopic approaches for the intraperitoneal tension-free mesh application have been introduced. The decreased trauma at the incision site and the reduction in wound infections appear to be the main advantages. The aim of the present study was to evaluate the early and long-term complications as well as patients’ contentment. Methods Laparoscopic hernia repair with intraperitoneal polytetrafluroethylene (PTFE) mesh implantation was performed on 62 patients at the Klinikum Grosshadern between 2000 and 2005 (29 males, 33 females age 60.7). Intra- and postoperative complications were registered prospectively and retrospectively analyzed. In addition, 57 patients were evaluated for recurrence, postoperative pain and patient contentment (median follow-up 409 days). Results A low complication rate was observed in our patient collective. One trocar bleeding occurred. Three patients presented with wound hematoma. The recurrence rate was 8% (2/25). Sixty-two percent of the patients were free of complaints postoperatively. Eighty-five percent would once again choose the laparoscopic approach for incisional hernia repair. Conclusion The laparoscopic technique was associated with a low recurrence rate, a small rate of wound infections and high patient comfort. Thus, the laparoscopic approach for mesh implantation appears to be a safe and effective method for the treatment of incisional hernias. The efficiency for laparoscopic intraperitoneal mesh implantation, however, should be further evaluated within a prospectively randomized multicenter trial. M. Stickel and M. Rentsch contributed equally.     

腹腔镜下腹壁切口疝修补术的临床疗效

目的探讨腹腔镜下手术治疗腹壁切口疝的临床疗效,为该病的治疗提供理论依据。 方法回顾性分析2014年9月至2016年8月,武警边防部队总医院收治的55例行腹腔镜下腹壁切口疝修补术患者的临床资料,对患者术前进行积极准备;术后严密监测生命体征变化情况,积极预防相关并发症的发生,做好出院指导,观察患者术后治疗效果。 结果55例患者均经腹腔镜顺利完成手术,手术时间80～150 min,平均123 min,术中出血量20～80 ml,平均40 ml,术后住院时间4～10 d,平均5 d。术后出现浆液肿2例,经穿刺抽液后给予腹带包扎处理后治愈;腹胀4例,均于3 d内自行缓解;术区疼痛2例,给予止痛药治疗后缓解;切口感染2例,给予积极换药处理后治愈,患者术后均未出现腹腔间室综合征、肠管损伤等严重并发症。随访时间3～24个月,平均11个月,均未出现切口疝复发。 结论对腹壁切口疝患者给予积极的术前准备后实施腹腔镜微创手术是安全、可行的,可促进患者快速康复,降低相关并发症的发生及切口疝的复发,值得临床进一步推广。     

腹腔镜复合补片无张力修补术治疗腹壁切口疝的临床体会

目的:探讨腹腔镜复合补片无张力修补术治疗腹壁切口疝的应用价值及可靠性。方法:回顾分析2007年1月至2012年1月为56例患者行腹腔镜复合补片修补术的临床资料。结果:3例因广泛粘连中转开腹,53例成功完成手术。手术时间70～320 min,中位手术时间110 min。术中发现隐匿性疝2例。术后Ⅰ级护理时间1天,术后24 h即恢复进食并下床活动。术后发生较长时间疼痛1例、感染1例。随访至今均未发现复发。结论:术后并发切口疝的患者于腹腔镜下分离粘连、采用复合补片修补是安全可行的。     

腹腔镜下腹壁切口疝修补术(附41例报告)

目的探讨腹腔镜下采用聚丙烯和膨化聚四氟乙烯复合补片（Bard Composix Mesh）修补腹壁切口疝的效果。方法2004年10月～2005年8月，对41例切口疝（腹壁缺损长径3～25cm，宽径3～18cm）腹腔镜下用超声刀进行腹腔内粘连松解和采用强生疝修补用缝合器行补片固定修补术。结果41例均顺利完成，无中转开腹。手术时间60～182min，平均85min。术后疼痛轻微，术后排便、排气时间25～41h，平均32h。术后第2天进食。术后住院5～7d，平均6d。41例随访6～16个月，平均9个月，未见切口疝复发。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。     

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.     

Prolonged abdominal wall pain caused by transfascial sutures used in the laparoscopic repair of incisional hernia

The use of transfascial sutures in the laparoscopic repair of incisional hernia has considerably facilitated the accurate intraperitoneal placement and fixation of the synthetic mesh. The laparoscopic procedure has a number of advantages, including less morbidity and pain. Moreover, the use of a mesh prosthesis results in a low rate of hernia recurrence. Despite the benefits associated with this technique, several (minor) complications have been documented. Herein we describe a case of prolonged abdominal wall pain after laparoscopic hernia mesh repair that was caused by the use of transfascial sutures.