老年腹壁切口疝的腹腔镜下修补术

Laparoscopic repair of incisional hernia with mesh in aged patients

目的探讨腹腔镜下应用补片行老年腹壁切口疝修补术的方法、安全性及临床效果。方法 2004年11月至2006年6月对17例老年切口疝患者行腹腔镜下应用补片切口疝修补术。结果 16例腹腔镜下行腹腔粘连松解和补片固定,顺利完成切口疝修补手术,1例因肠管与腹壁粘连紧密而中转开腹修补术。手术时间65～132 min,平均95 min。术后恢复排便、排气时间平均为31 h,术后住院5～7 d。术后并发症:疼痛3个月以上者3例,浆液肿5例,穿刺口感染1例,均经保守治疗后好转,无手术死亡和肠瘘发生。随访7～26个月(平均13个月),未见切口疝复发。结论腹腔镜下行腹腔内粘连松解,采用缝合器和缝线贯穿腹壁固定补片修补老年腹壁切口疝安全、有效。

Objective To investigate the methods, safety and efficacy of laparoscopic incisional hernia repair using mesh in aged patients. Methods Seventeen aged patients with incisional hernia accepted the laparoscopic mesh herniorrhaphy from November 2004 to June 2006. The clinical data were collected to investigate the effects and feasibility of the procedure, Results Sixteen patients completed the procedure successfully, 1 cases was converted to open operation because of extensive adhesion intraperitoneally. The operative time was 65 - 132 min （mean, 95 min）. Flatus or feces passed at 31 hours and hospital stay was 5 to 7 days after the operation. Post-operative complications： 3 patients suffered pain for more than 3 months and 5 developed seroma. Trocar incision infection occurred in one case. All complications were cured conservatively. No operation death and intestinal fistula occurred. No recurrence occurred during the follow- up period（7 -26 months,mean, 13 months）. Conclusions The laparoscopic incisional hernia repair using mesh after complete dissection of adhesion and fixation with stapler and suture is a safe and effective procedure for aged patients.