腹腔镜下腹壁切口疝修补术

Laparoscopic incisional hernia repaired with mesh

目的探讨腹腔镜下应用补片行腹壁切口疝修补术的方法、安全性及临床效果。方法2004年9月至2007年6月对56例切口疝(腹壁缺损长径7～19cm,宽径4～12cm)的患者行腹腔镜下应用补片行切口疝修补术。结果55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60～135min,平均92min。肠功能恢复早,术后排便、排气时间平均为31h,术后住院5～7d。术后并发症:术后疼痛达3个月以上者有9例,浆液肿8例。无手术死亡和肠瘘发生。随访16～28个月,平均19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来修补腹壁切口疝是一种安全、有效的微创方法,值得临床推广应用。

Objective To investigate the value and possibility of laparoscopic incisional hernia repair using mesh.Methods Seventeen elderly patients with incisional hernia（abdominal wall defects 7 to 19 cm in length size and 4 to 12 cm in horizontal size）were presented.The patients accepted the laparoscopic mesh herniorrhaphy in our hospital from September 2004 to June 2007.Results 55 patients were underwent treatment successfully,1 case was converted to open operation because of extensive adhesive intraperitoneally.The time of operative time was 60～135-min average（92-min）.postoperational flatus and feces were passed at 31-hour and postoperational hospital stay was 5-day to 7-day.Nine patients had over three months prolonged pain and eight patientshad seroma.No death and no intestinal fistula occurred postoperatively.No recurrence occurred in all cases with sixteen to twenty eight months average（ninteen months） follow-up.Conclusions The laparoscopic incisional hernia repair using mesh after complete dissection of adhesion and fixation with stapler and suture is a new safe and effective progress of less damageable operation.