小切口辅助腹腔镜巨大腹壁切口疝修补术的探讨

Small-incision Assisted Laparoscopic Repair for Huge Abdominal Incisional Hernia

目的总结小切口辅助腹腔镜巨大切口疝修补术的经验。方法 2008年6月-2009年12月,采用小切口辅助腹腔镜修补巨大切口疝15例,疝环（12.3±3.4）cm,采用小切口切除疝囊并进行腹壁塑形。结果 15例均顺利完成手术,手术时间100-150 min,（123.3±15.9）min。小切口长度5-8 cm,（6.0±0.9）cm。术中发现隐匿疝6例,一并予以修补。浆液肿1例。术后住院时间4-8 d,（5.3±1.2）d。1例术后疼痛持续〉3个月,无切口感染和肠道及腹腔脏器损伤。全组随访12-30个月,（19.9±4.7）月,无复发。结论小切口辅助腹腔镜修补巨大切口疝是一种安全可靠的手术方法,术后并发症少,达到了腹壁塑形的效果。

Objective To summarize our experience in laparoscopic repair of huge abdominal incisional hernia with the assistance of a small incision.Methods From June 2008 to December 2009,we performed small-incision assisted laparoscopy on 15 patients with huge abdominal incisional hernia.The mean diameter of the hernia ring of the patients was（12.3±3.4） cm.After removing the hernial sac,reconstruction of the abdominal wall was carried out.Results The procedure was completed in all the 15 cases within a mean operation time of（123.3±15.9） min（100-150 min）.The length of the small incision ranged from 5 to 8 cm with a mean of（6.0±0.9） cm.Hidden hernia was detected in 6 of the cases,and was repaired during the procedure.One patient was confirmed as having a serous cyst.After the operation,the patients was discharged from our hospital in 4 to 8 days with a mean of（5.3±1.2） days.One of the patients had postoperative pain for over three months but without incisional infection or injury to the intestine or other abdominal organs.We followed up the patients for（19.9±4.7） months（12-30 months）,and found no recurrent cases.Conclusions Small-incision assisted laparoscopic repair is safe and effective for huge abdominal incisional hernia with less complications and good outcomes in abdominal reconstruction.