改进后的腹腔镜腹腔内补片术在疝修补中的应用(附316例临床分析)

Evaluation of utilization of improved suture method in IPOM (intraperitoncal onlay mesh laparoscopic herniorrhaphy)

目的腹腔镜腹腔内补片植入术(IPOM),因有补片引起腹内组织粘连引发肠梗阻甚至复发等报道,目前争议较多,未能推广应用。作者改进了以上方法的多个步骤以克服该方法的不足,探讨改进后的方法在成人疝修补中的应用价值。方法以缝合小儿疝的方法关闭内环口;把补片的中心固定在疝环口的中心;经腹壁用可吸收线代替钉合枪以针织的方法把补片四周牢牢地固定并展平紧贴在腹膜上。利用脐内侧韧带腹膜覆盖网片的内侧:减少网片外露的面积,减少粘连发生。结果具有容易与腹膜相融合特性的网片能很快地与腹膜融合成一柔韧性组织,加强了疝环薄弱区,极少引起腹内肠管的粘连,更没有肠梗阻的发生,复发率低。结论作者认为经过改进后的IPOM方法是一种效果确切、创伤少、并发症少、费用低、有微创优点,值得继续探索应用。

[Objective] To utilize the suture method which has rather good effects in laparoscopoic hernioplasty in IPOM to conquer the short-comings of traditional IPOM. [Methods] To close the hernia sac in the suture method laparoscopic hernioplasty were applied in infants and children; the center of the mesh localized in the center of hernia neck were made; the lift-insert suture method was utilized for the laparoscopic hernioplasty in infants and children to extent and localize the Mesh; the medial half mesh was covered with the internal umbilical ligment in order to reduce the explosure of the mesh so as to decrease the incidence of inheresion. [Results] The Mesh infuse with the peritoneal strengthened the weakness area. There was no postoperative adherence and the recurrence rate was less than 1%. [Conclusions] The improved IPOM utilizing the lift-insert suture method has ideal clinical effect and it is a method of less damage, less postoperative complicationamd speedier recovery. It is worthy to be populized.