切换至 "中华医学电子期刊资源库"
高级检索
中华腔镜外科杂志(电子版)

中华腔镜外科杂志(电子版) ›› 2018, Vol. 11 ›› Issue (04): 241 -244. doi: 10.3877/cma.j.issn.1674-6899.2018.04.013

所属专题： 文献资源库；

短篇论著 上一篇    下一篇

腹腔镜切口疝修补术联合生物补片治疗巨大切口疝的疗效观察
戴伟钢 1, 魏丹 2, 袁玉杰 1, 谭进富 1, 左继东 1, 冯伟东 1, 赵琼云 1, 谭敏 1 , †( )   
  1. 1. 510080 广州，中山大学附属第一医院胃肠外科中心 疝与腹壁外科
    2. 528458 中山，广东药科大学医药化工学院
  • 收稿日期:2018-03-04 出版日期:2018-08-30
  • 通信作者: 谭敏
  • 基金资助:
    广东省公益研究和能力建设专项资金资助项目(2016A010103038)

The effect of laparoscopic herniorrhaphy combined with biological mesh in the treatment of giant incisional hernia

Weigang Dai 1, Dan Wei 2, Yujie Yuan 1, Jinfu Tan 1, Jidong Zuo 1, Weidong Feng 1, Qiongyun Zhao 1, Min Tan 1 , †( )   

  1. 1. Department of Gastrointestinal Surgery, Hernia and Abdominal Wall Surgery, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China
    2. School of Chemistry and Chemical Engineering, Guangdong Pharmaceutical University, Zhongshan 528458, China
  • Received:2018-03-04 Published:2018-08-30
  • Corresponding author: Min Tan
  • About author:
    Corresponding author: Tan Min, Email:
全文 ( ) 下载PDF ( )
目的

探讨腹腔镜切口疝修补术联合生物补片治疗巨大切口疝的疗效。

方法

回顾性分析2014年1月至2016年12月在中山大学附属第一医院接受腹腔镜切口疝修补术联合生物补片治疗的7例巨大切口疝患者的临床资料。

结果

手术时间70～390 min。疼痛程度的视觉模拟评分在术后24 h、术后3 d及术后7 d分别为(4.8±0.69)分、(4.1±0.89)分、(3.9±1.10)分。术后肛门首次排气时间(2.2±0.95)d，术后住院时间(18.2±9.2)d。术后发热3例(42.9%，3/7)，腹腔感染2例(28.6%，2/7)，切口脂肪液化3例(42.9%，3/7)，感染2例(28.6%，2/7)，腹壁血清肿2例(28.6%，2/7)，术后粘连性肠梗阻2例(28.6%，2/7)，补片下积液2例(28.6%，2/7)，肺部感染1例(14.3%，1/7)。所有患者获得随访，中位随访时间36个月；术后有腹壁慢性疼痛或不适感2例(28.6%，2/7)，术后24个月复发1例(14.3%，1/7)。

结论

腹腔镜切口疝修补术联合生物补片治疗巨大切口疝是安全有效的，但其长期疗效需要进一步观察。

关键词: 切口疝, 腹腔镜, 疝修补术, 生物补片, 疗效
Objective

The purpose of this article is to explore the therapeutic effect of laparoscopic hernia repair combined with biological patch in the treatment of giant incisional hernia.

Methods

The clinical data of seven patients with giant incisional hernia treated by laparoscopic incisional hernia repair combined with biological patch in our hospital from Jan. 2014 to Dec. 2016 were analyzed retrospectively.

Results

The operation time was from 70-390 minutes. The VAS pain scores on 24 hours operatively, POD3 and POD7 were(4.8±0.69), (4.1±0.89) and (3.9±1.10) respectively. The postoperative anal exhaust time was (2.2±0.95)days. The average postoperative hospitalization time was (18.2±9.2)days. The postoperative complications included three cases of fever (42.9%, 3/7), two cases of abdominal infection (28.6%, 2/7), three cases of fat liquefaction of incision (42.9%, 3/7), two cases of wound infection (28.6%, 2/7), two cases of abdominal wall seroma (28.6%, 2/7), two cases of adhesive intestinal obstruction after operation (28.6%, 2/7), two cases were filled by effusion (28.6%, 2/7), one case of pulmonary infection (14.3%, 1/7). All patients were followed up for an average of 36 months. Postoperative abdominal pain or discomfort occurred in two cases (28.6%, 2/7), and one case(14.3%, 1/7) recurred 24 months after operation.

Conclusions

Laparoscopic herniorrhaphy combined with biological patch is safe and effective for the treatment of huge incisional hernia, but its long-term effect needs further observation.

Key words: Incisional hernia, Laparoscope, Herniorrhaphy, Biological patch, Effect
图1 腹腔镜IPOM技术联合生物补片修补腹壁巨大切口疝
1
Dietz UA, MenzelS, Lock J, et al. The treatment of incisional hernia[J]. Deutsches Arzteblatt International, 2018, 115(3):31-37.
2
Franklin M, Russek K. Use of porcine small intestine submucosa as a prosthetic material for laparoscopic hernia repair in infected and potentially contaminated fields: long-term follow-up assessment[J]. Surg Endosc, 2011, 25(5):1693-1694.
3
Franklin ME, Gonzalez JJ, Glass JL. Use of porcine small intestinal submucosa as a prosthetic device for laparoscopic repair of hernias in contaminated fields: 2-year follow-up[J]. Hernia the Journal of Hernias & Abdominal Wall Surgery, 2004, 8(3):186-189.
4
Atema JJ, Vries FE, Boermeester MA. Systematic review and meta-analysis of the repair of potentially contaminated and contaminated abdominal wall defects[J]. American Journal of Surgery, 2016, 212(5):982-995.
5
Smart NJ, MarshallM, Daniels IR. Biological meshes: a review of their use in abdominal wall hernia repairs[J]. Surgeon, 2012, 10(3):159-171.
6
刘玉辉，安鲁彪，史冠军，等. 腹部切口疝修补术应用脱细胞真皮基质生物补片的疗效[J/CD]. 中华疝和腹壁外科杂志(电子版), 2015，9(4):309-311.
7
中华医学会外科学分会疝和腹壁外科学组，中国医师协会外科医师分会疝和腹壁外科医师委员会. 腹壁切口疝诊疗指南(2014年版)[J]. 中国实用外科杂志， 2014, 8(3):201-203.
8
唐健雄，郑民华，田文，等. 切口疝腹腔镜手术的规范化操作专家共识[J/CD]. 中华疝和腹壁外科杂志(电子版), 2016, 10(1):1-7.
9
占小莉，王跃东. 腹腔镜腹壁疝和切口疝修补术[J/CD]. 中华腔镜外科杂志(电子版), 2015, 8(1):5-7.
10
Franklin ME, Trevino JM, Portillo G, et al. The use of porcine small intestinal submucosa as a prosthetic material for laparoscopic hernia repair in infected and potentially contaminated fields: long-term follow-up[J]. Surg Endosc, 2008, 22(9):1941-1946.
11
Badylak S, Kokini K, Tullius B, et al. Strength over time of a resorbable bioscaffold for body wall repair in a dog model[J]. Journal of Surgical Research, 2001, 99(2):282-287.
12
Ueno T, Pickett LC, Sg DLF, et al. Clinical application of porcine small intestinal submucosa in the management of infected or potentially contaminated abdominal defects[J]. Journal of Gastrointestinal Surgery, 2004, 8(1):109-112.
13
Helton WS, Fisichella PM, Berger R, et al. Short-term outcomes with small intestinal submucosa for ventral abdominal hernia[J]. Archives of Surgery, 2005, 140(6):560-562.
14
Majumder A, Winder JS, Wen Y, et al. Comparative analysis of biologic versus synthetic mesh outcomes in contaminated hernia repairs[J]. Surgery, 2016, 160(4):828-838.
15
Gupta A, Zahriya K, Mullens PL, et al. Ventral herniorrhaphy: experience with two different biosynthetic mesh materials, surgisis and alloderm[J]. Hernia, 2006, 10(5):419-425.
16
Treviño JM, Jr FM, Berghoff KR, et al. Preliminary results of a two-layered prosthetic repair for recurrent inguinal and ventral hernias combining open and laparoscopic techniques[J]. Hernia the Journal of Hernias & Abdominal Wall Surgery, 2006, 10(3):253-257.
[1] 吴丰信, 吴英光, 俞建雄, 王胜. 腹腔镜辅助保留幽门胃部分切除术治疗早期胃中部癌近期疗效分析[J]. 中华普通外科学文献(电子版), 2021, 15(05): 326-330.
[2] 周仕海, 陈宏, 张静, 雒洪志, 冯春在, 孙浩, 钟思全. 结直肠肿瘤经自然腔道取出标本手术67例分析[J]. 中华普通外科学文献(电子版), 2021, 15(05): 340-343.
[3] 陈书德, 卢鹏, 林一鹏, 杨针, 张文智. 射频消融与腹腔镜肝切除治疗小肝癌的临床应用分析[J]. 中华腔镜外科杂志(电子版), 2021, 14(04): 201-205.
[4] 曲思娆, 赵曼曼, 李全红, 李芳, 马晶晶, 张义男, 景思然, 孙建丽. 无气腹V-NOTES与传统腹腔镜治疗卵巢囊肿临床疗效比较[J]. 中华腔镜外科杂志(电子版), 2021, 14(04): 217-220.
[5] 龙港, 高悦, 李爱东, 吕令伟, 李正天. 胰腺假性囊肿的腹腔镜手术治疗[J]. 中华腔镜外科杂志(电子版), 2021, 14(04): 248-253.
[6] 术者：张树彬 助手：邢中强 段佳悦 李昂 指导老师：刘建华 剪辑：徐晨. 健侧先行原位右半肝+全尾状叶切除的腹腔镜肝门部胆管癌根治术[J]. 中华肝脏外科手术学电子杂志, 2021, 10(06): 0-.
[7] 褚薛慧. 腹腔镜肝右后叶切除术[J]. 中华肝脏外科手术学电子杂志, 2021, 10(06): 0-.
[8] 卢攀 刘心怡 李坚 陈龙 张伟. 经脐单孔腹腔镜左半肝切除术[J]. 中华肝脏外科手术学电子杂志, 2021, 10(06): 0-.
[9] 张硕, 杨军, 顾元龙. 腹腔镜胆囊切除术致胆道损伤的危险因素及处理[J]. 中华肝脏外科手术学电子杂志, 2021, 10(05): 470-473.
[10] 吴志明, 黄洪军, 孟兴成, 葛佳皓, 沈丽青, 胡常恩, 虞洪. ERAS理念在腹腔镜胆总管切开取石一期缝合术中的应用[J]. 中华肝脏外科手术学电子杂志, 2021, 10(05): 474-478.
[11] 丁天龙, 谷保红, 李雪梅, 胡继科, 张凡, 冯泽东, 马斌, 王琛, 陈昊. "脱衣法"腹腔镜胆囊切除术的应用[J]. 中华肝脏外科手术学电子杂志, 2021, 10(05): 498-501.
[12] 王峰杰, 陈焕伟, 刘颖, 雷秋成, 宁燕文. 腹腔镜胰体尾切除手术入路及安全性[J]. 中华肝脏外科手术学电子杂志, 2021, 10(05): 506-509.
[13] 李国林, 王秀, 陈桂婵, 邱逸红. 腹腔镜胰十二指肠切除术围手术期标准化管理[J]. 中华肝脏外科手术学电子杂志, 2021, 10(05): 510-513.
[14] 李涛, 吐尔洪江·吐逊, 沙地克·阿帕尔, 白磊, 曹峻, 何翼彪, 王智鹏, 赵晋明. 全腹腔镜活体供肝右半肝切取术一例并文献复习[J]. 中华肝脏外科手术学电子杂志, 2021, 10(05): 514-518.
[15] 蓝炘, 朴成林, 安峰铎, 谈明坤, 司振铎, 吴蔚, 赵娜, 冷建军. 3D腹腔镜与2D腹腔镜下肝癌切除术的短期疗效比较[J]. 中华临床医师杂志(电子版), 2021, 15(05): 327-330.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号