腹腔镜下腹壁切口疝的治疗体会

The treatment experience of laparoscopic incisional hernia repair

目的：探讨腹腔镜切口疝修补术的临床应用效果。方法：回顾分析2010年7月至2014年6月为78例腹壁切口疝患者行腹腔镜切口疝修补术的临床资料,观察其治疗效果。结果：78例均顺利完成腹腔镜切口疝修补术,手术时间45~205min,平均（108.0±28.4）min,术中出血量15~55 ml,平均（30.0±6.8）ml,术后住院4~15 d,平均（6.5±2.1）d。发生血清肿2例（2.6%）,经加压包扎及穿刺抽液后好转;肠梗阻1例（1.3%）,经保守治疗后好转;膨出1例（1.3%）,发生于术后3个月,腹部不适症状明显,腹带加压包扎仍无明显好转,再次行腹腔镜修补术,术后随访1年未发生并发症;腹壁钉合区域疼痛9例（11.5%）,6例3~4周后基本缓解,3例疼痛持续1个月以上。术后随访3~24个月,平均（16.0±3.4）个月。结论：腹腔镜技术应用于切口疝修补术是安全、可行的,具有患者创伤小、康复快、并发症少、复发率低等优点。

Objective：To investigate the clinical effects of laparoscopic ineisional hernia repair. Methods：Clinical data of 78 patients who suffered from abdominal incisional hernia and underwent laparoscopie ineisional hernia repair from Jul. 2010 to Jun. 2014 were retrospectively analyzed and the treatment effects were observed. Results：All the laparoscopie operations were successfully per- formed. The operative time was （108.0± 28.4） min （range,45-205 min）,the blood loss was （30.0± 6.8 ） ml （range, 15-55 ml）,the postoperative hospital stay was （6.5 ± 2.1 ） d （range ,4-15 d）. Two cases （2.6%） of postoperative seroma were found and recovered after pressure dressing,puncture and drainage. Intestinal obstruction occurred in 1 case （1.3%） and cured after conservative treat- ment. 1 case （1.3%） of mesh bulging occurred in three months after operation with obvious abdominal discomfort symptoms, and there was no significant improvement after pressure dressing, laparoscopic incisional hernia repair was adopted once again and there was no postoperative complications during the follow up for 1 year. The pain in the surgical area of abdominal wall occurred in 9 cases （ 11.5% ）, in which 6 cases recovered after 3 to 4 weeks ,3 cases lasted at least for 1 month. There was no incisional infection, intestinal fistula. All cases were followed up for （16.0 ± 3.4） months （range,3-24 months）, no recurrence was found. Conclusions：The laparo- scopic incisional hernia repair is a safe, feasible and minimally invasive method for patients with incisional hernia with the advantages of little operative trauma, quick recovery ,few complications and low recurrence rate.