直接穿刺法建立第一穿刺孔及气腹在腹腔镜切口疝修补术中的应用

目的探讨腹腔镜切口疝修补术建立第一穿刺孔及气腹的临床经验。 方法回顾性分析2009年1月至2016年12月，中国人民解放军联勤保障部队920医院48例接受腹腔镜切口疝修补术患者的临床资料。 结果本组患者除4例中转外，其余患者均顺利完成手术。本组患者平均手术时间（157±90）min，术中平均出血（112±33）ml，术后平均住院时间（23±18）d。1例患者术后出现肠瘘，经保守治疗后治愈；另1例患者因肠粘连致肠梗阻，予以手术治疗后治愈。复发患者1例，再次于腹腔镜下修补，后患者无复发。本组患者建立第一穿刺孔及气腹过程中偶有腹壁血管损伤，无腹腔内肠管及重要血管损伤，术后无血清肿、慢性疼痛等。 结论无损伤可视套管直穿在腹腔镜切口疝修补术中建立第一穿刺孔及气腹比较安全、可靠。

Application of creating first trocar andpneumoperitoneum withdirect trocatin Laparoscopic incisional herniarepair

ObjectiveTo discuss the clinical experience of creating first trocar with direct trocar in laparoscopic incisional hernia repair. MethodsThe clinical data of 48 patients undergoing laparoscopic incisional hernia repair from January 2009 to December 2016 were retrospectively analyzed. ResultsIn this series, 4 patients needed to convert to laparotomy, the remaining patients were successfully completed surgery. The average operation time of the group was (157±90) minutes, the average bleeding was (112±33) mL, and the mean duration of the patients' stay in hospital was (23±18) days after operation. Another one patient had intestinal fistula after operation and was cured after conservative treatment. The other one patient with intestinal obstruction which was caused by intestinal adhesion, was cured by surgical treatment. One patient who was recurred were repaired by laparoscope again, and no recurrence was found after this operation. This group of patients had occasional abdominal vascular injured, no bowel and important vascular injured in creating first trocar, and none had seroma or chronic pain. ConclusionIt is safe and reliable to establish the first trocar and pneumoperitoneum with direct trocar in the laparoscopic incisional hernia repair. It is worthy to spread.