腹腔镜下切口疝补片修补术的临床应用

目的 探讨腹腔镜下腹壁切口疝修补术的手术方法、安全性等问题。方法对2004年3月至2006年5月79例行腹腔镜下补片修补术治疗腹壁切口疝病人的临床资料进行分析。结果 78例（98．7％）手术成功，1例因腹腔内广泛粘连而中转开放修补。平均手术时间为88min，平均术后住院4．6d，18例（22．8％）病人术中发现有1个以上的隐匿性缺损。术后并发症：术后短期内修补区腹壁明显疼痛58例（73．4％）。腹壁缝合点较长时间疼痛6例（7．6％），浆液肿14例（17．7％），无手术死亡，1例术后出现肠瘘，经保守治疗好转，1例腰部切口疝的病人术后复发。结论 多数病人腹壁切口疝可以经腹腔镜行粘连松解及补片修补术，并可在术中发现其他隐性缺损，手术安全性较高。对腹腔内广泛粘连而影响操作器械进入及粘连分离者，应及时中转开腹手术。

Clinical experience of incisional hernia repair with meshes in Laparoscopic technique

Objective To investigate the security and the operative experiences of laparoscopic ventral incisional herniorrhaphy.Methods The laparoscopic mesh repair was performed for 79 patients with abdominal ventral incisional hernias from March 2004 to May 2006 in Hua Shan Affiliated Hospital of Fu Dan University.Results Laparoscopic incisional herniorrhaphy with meshes was successfully performed in 98.7%(78/79) of patients.One case(1.3%) was converted to an open procedure because of extensive adhesion intraperitoneally.The mean operating time was 88 minutes and postoperative hospital stay averaged 4.6 days.Eighteen(22.8%) patients were found to have more than one hernial defect intraoperatively.Postoperative complications included severe pain in operative area temporary(n=58,73.4%),prolonged pain in suture site(n=6,7.6%),seroma(n=14,17.7%),intestinal fistula(n=1,1.3%) and recurrence(n=1,1.3%).Conclusion Laparoscopic ventral incisional herniorrhaphy with meshes can be performed in most of incisional hernias after complete dissection of adhesions,through the laparoscopy it may find others defects.But the postoperative pain is severe in repair area.If extensive dense adhesion will interfere with the manipulation and lysis,the patients should be converted to open operation.