腹腔镜下腹腔内补片修补术治疗腹壁切口疝的临床研究

Clinical study of laparoscopic intraperitoneal onlay mesh technique for the treatment of abdominal incisional hernia

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。

Objective To discuss the safety and feasibility of the laparoscopic intraperitoneal onlay mesh technique for the treatment of abdominal incisional hernia.Methods The clinical data of 103 patients undergoing laparoscopic intraperitoneal onlay mesh technique for abdominal incisional hernias in the General Hospital of the Southern Theater from 2014 to 2019 were retrospectively analyzed.Observing the operation time,postoperative exhaust time,hospitalization time,complications and recurrence.Results All operations were successfully completed.The average operation time,postoperative exhaust time and hospitalization time were(100±10)min,(40±8)h and(7.5±1.5)d,respectively.During the operation,one case was found to be combined with an umbilical hernia and we performed a hernioplasty.Another case was combined with right direct inguinal hernia and we performed transabdominal preperitoneal hernia repair.The third case with incarcerated intestinal obstruction was combined with intestinal necrosis,and we performed enterotomy anastomosis.Minor postoperative complications were resolved with short-term treatment.All patients were followed for 3 to 24 months without hernia recurrence.Conclusion Laparoscopic intraperitoneal onlay mesh technique for the treatment of abdominal incisional hernias is safe,effective,minimally invasive,and has the advantages of occult hernia detection,rapid recovery,a low complication rate,a short hospitalization time,a low recurrence rate,etc.