腹腔镜下复合补片修补耻骨上切口疝(附25例报道)

Analysis on Curative Effect of Laparoscopic Repair for Suprapubic Incisional Hernia Using Composite Patch

目的总结腹腔镜下耻骨上切口疝修补的手术方法及效果。方法回顾性分析2007年3月至2010年10月期间笔者所在科室25例行腹腔镜下耻骨上切口疝修补术患者的临床资料。男13例,女12例;年龄35～83岁,中位年龄52岁;其中2例是复发疝。疝缺损下缘距耻骨弓距离均小于5 cm。在直视下采用螺旋钉枪将补片固定到腹壁上,补片下边缘须低于耻骨弓2 cm并将其固定到耻骨弓及双侧的耻骨梳韧带上。结果 25例患者均成功完成腹腔镜下切口疝修补,无中转开腹。疝缺损最大径为6.1～12.5 cm,平均9.5 cm。手术时间为90～180 min,平均128 min。总并发症发生率为28%(7/25)。包括术中膀胱损伤1例;术后补片上方浆液肿4例,经局部穿刺抽吸后消失;术后修补区域腹壁疼痛2例,未行特殊处理于术后1个月内逐渐缓解并消失。22例患者获随访,随访率为88%,随访时间为6～48个月,平均30个月,1例于术后2个月复发,复发率为4%。结论腹腔镜下耻骨上切口疝修补是一种安全有效的方法,其网片重叠缺损边缘至少超过5 cm,网片下边缘必须在直视下固定到双侧耻骨梳韧带上,这样可以增加固定的强度并降低修补术后复发率。

Objective To summarize the surgical technique and curative effect of laparoscopic repair for suprapubic incisional hernia using composite patch. Methods The clinical data of 25 cases performed laparoscopic repair of suprapubic incisional hernia using composite patch from March 2007 to October 2010 were reviewed retrospectively.There were 13 males and 12 females,and aged 35-83 years（median age was 52 years）.Among them 2 patients were recurrences.The distance between the lower margin of hernia defect and pubic arc was less than 5 cm.The composite patch was fixed to the abdominal wall using spiral tacks（Protack） in direct vision.The lower margin of the patch was lower to the pubic arc in 2 cm,and to be fixed to the pubic arc and bilateral pectineal ligament,and it should be extended.Results Laparoscopic repair were successfully performed in all patients without convert to open repair.The max diameter of the hernia ring was 6.1-12.5 cm and the average was 9.5 cm.The average operating time was 128 min（ranging from 90 to 180 min）.And the total complication rate was 28%（7/25）,including bladder damage during operation in 1 case,wound seroma upon the patch in 4 cases and cured by aspiration,pain in the operative area and disappeared within one month without intervention in 1 case.Twenty-two patients were followed-up with a follow-up rate of 88%.During a follow-up range of 6-48 months（average 30 months）,one case recurrence occurred in 2 months after the repair with the recurrent rate of 4%.Conclusions Laparoscopic repair of suprapubic incisional hernia is a safe and feasible technique,and the patch should cover and exceed the margin of the defect for 5 cm in all direction.The lower margin of the patch should be fixed to the bilateral pectineal ligament so as to strengthen the fix,and lower the recurrence rate.