腹腔镜下腹壁巨大切口疝修补术的临床应用

Clinical experience in repair of huge incisional hernia with mesh by laparoscopic technique

目的探讨腹腔镜下应用补片修补巨大腹壁切口疝的手术方法及临床效果。方法分析25例应用腹腔镜下补片修补腹壁巨大切口疝（腹壁缺损长径为12～25cm，宽9～18cm，缺损面积108—451cm^2）患者的临床资料。结果21例（84．0％）顺利完成腹腔镜下腹壁切口疝修补术，4例（16．0％）因肠管与腹壁粘连紧密而中转开腹。手术时间78～186（平均95）min。术后住院5～8d，平均6．5d。术后疼痛达3个月以上8例（32．0％），经治疗后缓解；浆液肿9例（36％）。无切口感染和肠瘘发生；无手术死亡。全组患者随访6～25（平均11）个月，无切口疝复发。结论腹腔镜下修补腹壁巨大切口疝是一种安全、有效的方法，对腹腔粘连重分离困难者应及时中转开腹。

Objective To investigate the technique and outcome of laparoscopic repair of huge ventral incisional hernia using mesh. Methods The clinical data of 25 patients with huge incisional hernia （ abdominal wall defects 12 to 25 cm in length size and 9 to 18 cm in horizontal size, defect area of 108 - 451 cm2） were analyzed, Results Twenty-one patients （84 % ） underwent hernia repair successfully, 4 cases （16 % ） were converted to open operation because of extensive adhesions intraperitoneally. The operative time was 78 - 186 （ average 95 ） min. Postoperative hospital stay was 5 - 8 （ average 6. 5 ） days. Eight patients （ 32 % ） had prolonged pain over three months, and nine patients （ 36 % ） had seroma. No death, intestinal fistula , or infection occurred postoperatively. No recurrence occurred in any of the cases within 6 to 25 months （ average eleven months ） follow-up. Condusions The laparoscopic repair of huge incisional hernia using mesh is a new, safe and effective operation. If extensive dense adhesions interfere with dissection , the procedure should be converted to open operation.