腔镜修复术治疗结肠造口旁疝

Investigate the skillful elements in laparoscopic parastomal herniorraphy with meshes

目的总结腔镜下补片修补造口旁疝的手术技术要点。方法回顾性分析2004年9月至2006年11月复旦大学附属华山医院外科收治的16例行腔镜修补术治疗结肠造口旁疝病人的临床资料。结果16例造口旁疝病人中,14例修补成功,2例中转为开放缝合修补（1例因腹腔内广泛致密粘连,1例因小肠损伤）。手术时间平均116min（45～180min）。疝环直径平均5.4cm（4～6cm）。术后出现暂时性腹胀4例,修补区域腹壁疼痛12例（最长持续3周后明显缓解）,1例出现呼吸功能减退（经使用无创呼吸机辅助治疗后缓解）,7例出现浆液肿（经2～4次穿刺抽液并加压包扎后治愈,无血肿发生,未发生与手术相关的感染）。术后住院时间平均5.4d（3～8d）。术后随访平均7个月（1～17个月）,未见早期复发,疝囊较小和发病初期就行修补术者外观优于疝囊较大和发病时间较长者。结论腹腔镜造口旁疝补片修补术从技术上讲是安全、可行的,从早期的临床结果来看,效果亦较理想。

Objective To summarize the effectiveness of laparoscopic parastomal hemiorrhaphy with meshes. Methods A laparoscopic mesh repair was performed for 16 patients with parasromal hernias from September 2004 to November 2006 in Hua Shan Hospital,Shanghai Medical College of Fu Dan University. Results Laparoscopie parastomal herniorrhaphy with meshes was successfully performed for 14 patients ,Two cases were converted to an open procedure because of extensive adhesion （ n = 1 ） and intestine damaged （ n = 1 ）, The average operating time was 116 min （range,45 -180 min）, The mean hernia defect was 5.4 cm （range,4 -6cm） and postoperative hospital stay averaged 5.4 days（ range,3 -8 days）, Twelve patients complained the temporary pain in operative area and 7 patients were occurred in seroma. One patient felt dyspnea, which ameliorate by the assistant of VPAP. There was no wound infection or early recurrence in the cases. The local appearance was better in patients with small hernia sac or who accept herniaraphy earlier than in those with larger hernia sacs or who accept operation later. Conclusion Laparoscopic parastomal herinorrhaphy with meshes is a security, feasibility and effective method.