经腹部分腹膜外修补术治疗下腹壁切口疝

Transabdominal Partial Extraperitoneal Repair for Lower Abdominal Wall Incision Hernia

目的探讨经腹部分腹膜外修补术(transabdominal partial extraperitoneal repair,TAPE)治疗下腹壁切口疝的安全性和有效性。方法回顾性分析2015年4月～2017年6月TAPE治疗下腹壁切口疝5例的临床资料,3例阑尾炎术后麦氏切口疝(包括1例复发疝),1例乙状结肠癌造口处切口疝,1例髂腹股沟入路骨盆骨折内固定术后切口疝。疝环长径3.5～6.0 cm,平均4.5 cm。使用生物可吸收涂层/永久性网片。术后常规腹带包扎3个月。结果本组5例均顺利完成TAPE,手术时间90～130 min,平均112 min,术中出血量15～50 ml。术后常规使用非甾体抗炎药镇痛3天,术后住院5～10 d。血清肿1例,经加压包扎及穿刺抽液治愈。术后随访2～26个月,无复发,无并发症发生。结论对合适患者,规范的TAPE是治疗下腹壁切口疝的一种安全、有效的微创技术,远期疗效有待长时间随访观察及大样本量数据进一步佐证。

Objective To explore the safety and efficacy of transabdominal partial extraperitoneal repair （TAPE） for lower abdominal wall incision hernia. Methods A retrospective analysis was made on the clinical data of 5 cases with lower abdominal wall incision hernia trated by TAPE from April 2015 to June 2017 in our hospital. There were 3 cases of incision hernia after appendicitis （including one recurrent hernia） , 1 case of sigmoid eolostomy site incision hernia after the stoma apothesis, and 1 case of internal fixation of pelvic fracture via ilioinguinal approach. The length of the ring ranged 3.5 - 6.0 em （ mean, 4.5 cm）. The mesh used was bioabsorbable coating/permanent mesh sheet. Abdominal band dressing was routinely used for 3 months after operation. Results All the 5 patients were successfully operated under TAPE. The operation time was 90 - 130 rain （mean, 112 min）. The bleeding amount was 15 - 50 ml. The non-steroidal analgesics was routinely used for 3 days postoperatively. The postoperative hospitalization was 5 -10 d. Seroma occurred in 1 ease, and disappeared after compression bandaging and puncture. Postoperative follow-up was conducted for 2 - 26 months, and no recurrence or other complications oeeutTed. Conclusions For suitably selected patients with lower abdominal wall incision hernia, standard TAPE is a safe and effective minimally invasive technique. It＇ s long-term curative effect and safety needs longer time＇ s follow-up observation and further evidence from larger sample size.