腹腔镜穿刺孔疝11例临床分析

Clinical Analysis of 11 Cases of Laparoscopic Port-Site Hernia

目的总结腹腔镜穿刺孔疝(PSH)的高危因素、临床特点及诊治方法。方法回顾性分析2015年1月至2022年12月诊治的11例PSH临床资料并总结国内外相关文献。结果PSH发生位置脐周7例,腹侧壁4例,穿刺孔直径均≥10 mm;出现症状的中位数时间为7 d,主要症状为恶心呕吐(8/11)及腹痛(10/11),均存在穿刺孔处包块,7例伴有压痛;影像学检查均提示PSH,疝环面积1~5 cm^(2),平均为2.1 cm^(2)。10例早发型行手术修补,疝内容物7例为小肠(4例缺血坏死),3例为大网膜(均缺血坏死),随访5~73个月,愈合良好;1例迟发型行手法还纳,随访35个月,复发2次。结论PSH的发生与穿刺孔位置、直径相关。症状以腹痛、恶心呕吐为主,体征为穿刺孔处包块,可伴有压痛,严重时并发疝内容物缺血坏死,诊断需结合患者手术史、症状体征及影像学检查,治疗方法主要为手术修补,预后良好。

Objective To summarize the risk factors,clinical characteristics and treatment of laparoscopic port-site hernia(PSH).Methods The clinical data of 11 cases of PSH from January 2015 to December 2022 were retrospectively analyzed and the related literature at domestic and abroad were summarized.Results The location was periumbilical in 7 cases,lateral abdominal wall in 4 cases,puncture hole diameter≥10 mm.The median time of symptoms was 7 days,The main symptoms were nausea and vomiting(8/11)and abdominal pain(10/11).There were mass at the puncture hole,and 7 cases were accompanied by tenderness.Imaging examination showed PSH,averagehernia ring area was 2.1 cm^(2)(range 1~5 cm^(2)).10 cases of early type underwent operation,7 cases of hernia contents were found in small intestine(4 cases of them were ischemic necrosis),3 cases of greater omentum(ischemic necrosis).They were followed up for 5~73 months and healed well.One case of delayed type underwent conservative treatment,and was followed up for 35 months and recurred twice.Conclusion The occurrence of PSH is related to the location and diameter of the puncture hole.The main symptoms are abdominal pain,nausea andvomiting.The signs are mass at the puncture hole,which can be accompanied by tenderness.Severe cases are complicated with hernia necrosis.Diagnosis should be combined with surgical history,symptoms and signs and imaging examination.The treatment method is mainly surgical repair,and the prognosis is good.