从原发性腹壁疝的含义和特点谈微创术式进展

Advances in minimally invasive procedures based on the concept and characteristics of primary ventral hernias

腹壁疝和原发性腹壁疝有不同的含义,本文原发性腹壁疝是指非手术引起的位于腹前外侧壁和后腹壁的腹外疝(不含腹股沟疝和股疝)。原发性腹壁疝患者无手术切口,更愿意接受微创治疗,其腹壁组织完整,也有利于微创新技术的开展。原发性腹壁疝的疗效显著优于切口疝。目前,微创术式众多,在原发性腹壁疝中可最大程度体现各自的优势。腹腔镜腹腔内补片修补术(IPOM)和微创非腹腔内补片修补术(MINIM)理念不同,技术互补,共同目标是追求微创和腹壁功能重建。MINIM的主要术式是各类腔镜腹膜外修补术(EER),大多从原发性腹壁疝起步,逐步发展并扩大其适应证。另一类术式是腔镜辅助肌前修补术(onlay),在中线位原发性腹壁疝中发挥特有的作用。脐疝、腹直肌分离、原发性耻骨上疝、半月线疝和原发性腰疝等是较常见的原发性腹壁疝,本文逐一讨论,阐述其定义、特点及微创术式的进展。

Ventral hernia and primary ventral hernia have different meanings.In this article,primary ventral hernia refers to non-surgically induced hernias located on the anterolateral and posterior abdominal walls(excluding inguinal and femoral hernias).Patients with primary ventral hernias do not have surgical incisions and are more willing to undergo minimally invasive treatment.Meanwhile,their intact abdominal wall tissue is suitable for applying novel minimally invasive techniques.The therapeutic efficacy of primary ventral hernias is significantly better than that of incisional hernias.Currently,there are numerous minimally invasive procedures,each reflecting its own advantages in the treatment of primary ventral hernias.The laparoscopic intraperitoneal onlay mesh repair(IPOM)and the minimally invasive non-intraperitoneal mesh repair(MINIM)have different concepts but complement each other technologically,with the common goal of pursuing minimally invasive procedures and abdominal wall functional reconstruction.MINIM dominantly consists of various endoscopic extraperitoneal repair procedures(EER),most of which start from primary ventral hernias and gradually expand their indications.Another type of procedure is laparoscopic-assisted onlay repair,which plays a unique role in primary midline ventral hernias.Umbilical hernias,diastasis recti,primary supra-pubic hernias,Spigelian hernias,and primary lumbar hernias are commonly encountered types of primary ventral hernias.This article discusses each of them individually,elucidating their definitions,characteristics,and the progress of minimally invasive procedures.