腹腔镜下切口疝修补术并发症的处理

目的探讨腹腔镜下切口疝补片修补术后并发症发生的原因及处理方法。方法回顾性分析2004年3月～2007年5月采用腹腔镜补片修补术治疗的110例切口疝的临床资料。男42例，女68例，年龄33～89岁（平均65岁）。结果1例因腹腔内广泛粘连而中转开放修补，余109例手术成功。术后并发症：术后腹胀15例（13．6％），修补区腹壁疼痛86例（78．2％）（其中2例持续时间≥6周），血清肿23例（20．9％），尿潴留6例（5．4％），急性胃扩张2例（1．8％），肠管损伤2例（1．8％），呼吸功能障碍2例（1．8％），复发2例（1．8％）。结论术前准备不足，腹腔内的粘连，视野暴露困难，盲目电凝操作，补片偏小及固定不恰当等是导致手术并发症的关键。

Treatment for Complications of Laparoscopic Incisional Hernias Repair

Objective To explore the causes and treatments for complications of laparoscopic incisional hernia repair. Methods A total of 110 patients with incisional hernia （42 men and 68 women, aged 33 to 89 years with a mean of 65） were treated with laparoscopic mesh repair in our hospital from March 2004 to May 2007. The clinical records of the patients were analyzed retrospectively. Results The laparoscopic repair was completed in all of the patients expect in one, who was converted to open surgery because of intraperitoneal adhesion. After the operation, 15 （ 13.6% ） patients developed abdominal distension, 86 （78.2%） had severe pain in the operative area （not less than 6 weeks in 2 cases） , 23 （20.9%） had seroma, 6 （5.4%） had urinary retention, 2 （1.8%） had acute gastric dilation, 2 （1.8%） had intestinal fistula, 2 （ 1.8% ） had respiratory dysfunction, and 2 （ 1.8% ） showed recurrence of the hernia. Conclusion Most of the comPlications of laparoscopic incisional hernia repair are caused by insufficient preoperative preparation, intraperitoneal adhesion, difficulty in exposure of the visual field, improper use of eleetroeoagulation,small-sized masses, or weak fixation.