扩大经腹膜前修补手术治疗成人获得性腰疝的临床研究

目的探讨扩大经腹膜前(Sublay)手术修补治疗成人获得性腰疝的有效性及手术要点。方法回顾性分析2010年1月至2014年12月华中科技大学同济医学院附属武汉中心医院疝与腹壁外科采用扩大经腹膜前手术方式治疗的24例成人腰疝病人的临床资料。其中男性17例,女性7例;年龄47~79岁,平均(59.6±11.2)岁;右侧19例,左侧5例;初发22例,复发疝2例;开放行肾脏切除术病人12例,开放肾脏切开取石术病人3例,开放耻骨截骨术病人1例,腹腔镜肾囊肿开窗术病人2例,腹腔镜肾上腺瘤切除术病人2例,腰部闭合外伤病人4例。结果 24例腰疝扩大经腹膜前修补手术均顺利完成,术中无肾脏、输尿管及肠管损伤,术后疼痛需使用镇痛剂辅助治疗病人2例,使用时间1周;术后住院时间为7~15 d,平均(10.3±1.2)d;术后7 d时所有病人均未见局部血肿、伤口感染及脂肪液化发生。术后随访时间为6~48个月,平均随访时间为(15.3±3.2)个月,所有病人均获得随访,未见腰疝复发,无慢性疼痛及补片感染发生。结论扩大经腹膜前修补手术证实是治疗成人获得性腰疝的一种安全有效的手术方式。

Clinical research of the Sublay hernioplasty in adult patients with lumbar hernia

Objective To investigate the clinical efficiency of Sublay hernioplasty in adult patients with lumbar hernia.Methods The clinical data of 24 patients with lumbar hernia undergoing Sublay hernioplasty were analyzed retrospectively.There were 17 males and 7 females with average age of 59 years old.There were 5 cases of the left lumbar hernia and 19 cases of the right.There were 22 patients with primary hernias and 2 patients with recurrent hernias.Twelve cases were subjected to radical nephrectomy, 3 cases to kidney stone surgery, 1 case to pubic bone osteotomy, 2 cases to laparoscopic fenestration for renal cysts, 2 cases to laparoscopic resection for adrenal tumor, and there were 4 cases of waist closed injury.Results The operations were performed successfully in all patients.There were no injuries of the kidney, bowel and ureter during the operation.There were 2 patients administered with analgesics for 1 week after the operation.The postoperative hospital stay was 7-15 days, with an average time of 10.3 days.There was no infection of obstetric surgical wound, hematoma and fat liquefaction after operation.During the period of 6 to 48 months of follow-up, no recurrence, chronic pain and material infection occurred in all patients.Conclusions The Sublay hernioplasty in the treatment of lumbar hernias is safe and feasible.It's typically appropriate for adult patients with lumbar hernias.