腹腔镜联合开放手术方式修补腹壁切口疝

Combined laparoscopic and open surgical repair for abdominal incisional hernia

目的探讨新型杂交手术方式在腹壁切口疝修补术中的应用。方法回顾性分析2013年1月至2014年1月,广东省人民医院60例腹壁切口疝患者,在开放方式下将补片一侧固定于腹腔内,于腹腔镜方式下完成其余部位的方式固定的新型杂交方式,分析其临床特点及并发症的发生率。结果中切口疝11例（18.3%）,大切口疝26例（43.4%）,巨大切口疝23例（38.3%）。手术时间75~120（90±14）min,住院天数4~9（6.0±1.2）d,术后随访时间3~12（8.0±2.5）个月。术后脂肪液化1例,经保守治疗及门诊随访,1周后恢复。切口感染1例,予以门诊输液及换药治疗,2周后切口感染治愈。术后无慢性疼痛患者,亦未见复发患者。结论新型杂交手术方式对适当选择的腹壁切口疝患者来说,术后并发症发生率低,总体效果显著,具有可行性。

Objective To explore a novel hybrid surgery in abdominal incisional hernia repair.Methods From January 2013 to January 2014,60 patients with incisional hernia in Guangdong People＇ s Hospital were retrospectively analyzed. All patients received a novel hybrid surgery： one side of mesh was fixed in the open part,and the fixations of the other side were completed under laparoscopy. The clinical characteristics and complications were noted. Results These 60 incisional hernias included 11（ 18. 3%）cases of middle incisional hernia,26（ 43. 4%） of large,and 23（ 38. 3%） of giant. The average operation time was（ 90 ± 14） minutes（ range 75 to 120 minutes）,the average hospitalization time was（ 6. 0 ±1. 2） days（ range 4 to 9 days）. After a mean follow-up of（ 8. 0 ± 2. 5） months（ range 3 to 12 months）,1 case developed postoperative fat liquefaction,which recovered in 7 days after conservative treatment.Incision infection occurred in 1 case,and it was treated with outpatient infusion and dressing change. The wound infection was cured after 2 weeks. There were no recurrence or chronic pain after surgery.Conclusion The postoperative complication rate of this new hybrid operation is low,and the overall effect is remarkable. It has the feasibility for appropriate patients with incisional hernia.