腹腔镜下切口疝补片修补术的临床应用

The preliminary experience in laparoscopic abdominal ventral incisional hernia repair with meshes

目的探讨腹腔镜下腹壁切口疝修补术的手术方法、安全性等问题。方法对我院2004年3月至2005年7月间收治的42例腹壁切口疝患者,采用腹腔镜下修补术。结果41例(97.6%)手术成功,1例(2.4%)因腹腔内广泛粘连而中转为剖腹修补。平均手术时间为96 min,平均术后住院4.8 d,9例(21.4%)患者术中发现有一个以上的隐匿性缺损。术后并发症:术后短期内修补区腹壁明显疼痛36例(85.7%),腹壁缝合点较长时间疼痛6例(14.3%),浆液肿8例(19%),无修补区感染,未发现早期复发的病例。结论对腹壁切口疝,多数患者是可以经腹腔镜进行粘连松解及补片修补术的,并可在术中发现其他隐性缺损。对腹腔内广泛粘连而影响操作器械的进入及粘连分离者,应及时中转剖腹手术。

Objective To investigate the security and the operative experience of laparoscopic ventral incisional herniorrhaphy. Methods A laparoscopic mesh repair was performed on 42 patients with abdominal ventral incisional hernias from March 2004 to July 2005 in our hospital. Results Laparoseopic incisional herniorrhaphy with meshes was successfully performed on 41 patients （97.6%）. One case （2.4%） was converted to an open procedure because of extensive adhesion intraperitoneally. The mean operating time was 96 min and postoperative hospital stay was 4.8 days on average. Nine （21.4%）patients were found to have more than one hernial defect which was missed preoperatively. Postoperative complications included severe pain in operative area temporary （ n = 36,85.7 % ）, prolonged suture site pain （ n = 6,14.3 % ） ,seroma （ n = 8,19 % ）, but there was no wound infection and early recurrence in our cases. Conclusion Laparoscopic ventral incisional herniorrhaphy with meshes can be performed on most of incisional hernias after complete dissection of adhesions, and under the laparoscopy other missed defects could be found. For those with extensive and dense adhesion,open operation is needed.