内镜下经腹Sublay修补术在腹壁疝治疗中的应用

Endoscopic trans-abdominal sublay repair for the surgical treatment of ventral hernia

目的初步评估经腹Sublay修补(transabdominal sublay,TAS)修复腹壁疝的可行性、安全性和有效性,并从初步临床实践中总结其手术要点和适应证。方法回顾研究2016年5月至2019年5月同济大学附属东方医院等四家医院实施的21例中小型原发性腹壁疝和切口疝患者的资料,分析病例资料、疝的情况、手术细节和手术结果。结果21例计划实施TAS修补的患者中,19例成功完成,另2例中转完成修补。手术中位时间120 min,术后48 h绝大部分患者仅存在轻度疼痛。无术中、术后严重并发症;血清肿是最常见并发症(15.8%),都在6个月内吸收;1例复发。结论初步结果表明,TAS修补对于治疗中小型原发性腹壁疝和切口疝是可行、安全、有效的;但手术耗时较长,实施手术的外科医师需要更多的耐心和技巧,但成功实施TAS可避免将补片放置入腹腔,患者术后恢复也更快。

Objective This study was undertaken to evaluate the feasibility,safety and effectiveness of TAS(transabdominal sublay)repair for ventral hernia.Its critical surgical skills and indications are also summarized from the preliminary practice.Methods This retrospective study reviews 21 cases with small-to-median primary ventral or incisional hernias performed with TAS repair from 4 Chinese hospitals between May 2016 and May 2019.Patient demographics,hernia characteristics,operative variables and surgical results were recorded and analyzed.Results In 21 cases,TAS repair was implemented successfully in 19 cases;in the other two cases,the repairs were completed by transferring to other procedures.The median operation during was 120 min.The most majority of the patients had only mild pain at 48 h post-operation.No severe intraoperative and postoperative complication occurred.Seroma was the most frequent complication(15.8%)and all absorbed in six months.There was one recurrence.Conclusions TAS repair is feasible,safe and effective for the treatment of small-medium primary ventral and incisional hernias.But the procedure takes long time and the surgeons need more patience and skills.However,the successful implement of TAS repair avoids placing the mesh in the abdominal cavity and brings quick postoperative recovery.