腹腔镜腹壁切口疝修复术中腹壁功能重建

Abdominal wall functional reconstruction in laparoscopic ventral and incisional hernia repair

腹壁切口疝的治疗已从单纯的修补(repair)、加强(reinforcement)向重建(reconstruction)、重塑(restora⁃tion)和再生(regeneration)进展。腹壁切口疝有肌前、肌后、腹膜前、腹腔内等修补层次,均可通过开放或腹腔镜手术来完成。腹腔镜手术主要包括腹腔内补片修补术(IPOM)和微创非腹腔内补片修补术(MINIM)。无论哪种技术,既要遵循腹壁功能重建的原则,又要结合自身的微创特性,才能充分体现其临床价值。腹腔镜腹壁切口疝术中腹壁功能重建的核心可归纳为恢复腹壁解剖结构(Anatomy),保护腹壁生物力学(Biomechanics),维持腹壁顺应性(Compliance),提供机体整体动态活力(Dynamics)。

The treatment of ventral and incisional hernias has progressed from simple repair and reinforcement to reconstruction,restoration,and regeneration.There are Onlay,Sublay,preperitoneal,intraperitoneal repair planes,and each plane could be performed via open or laparoscopic surgery.Laparoscopic surgery mainly includes intraperitoneal onlay mesh(IPOM)and minimally invasive non⁃intraperitoneal mesh(MINIM)repair.Regardless of the technique applied,it is essential to follow the principles of abdominal wall functional reconstruction and minimally invasive features to demonstrate their clinical value.The core of abdominal wall functional reconstruction in laparoscopic surgery for ventral and incisional hernias could be summarized as restoring Anatomical structure,protecting Biomechanics,maintaining Compliance,and providing overall Dynamic support for the body.