腹腔镜巨大腹壁切口疝修补术.DOCVIP

临床医学论文-腹腔镜巨大腹壁切口疝修补术 ????????? 作者：陈明，缪辉来，陈念平，林木生，李宇洲，包仕廷，徐浩 【摘要】? 目的：探讨腹腔镜治疗巨大腹壁切口疝的手术方法及手术要点。方法：２００４年９月在完全腹腔镜下用补片法修补１例巨大腹壁切口疝，疝环１２cm×１５cm。结果：手术顺利完成，手术时间１００min，术后肺部感染，经抗感染治愈，无其他手术并发症，术后７d出院。随访７个月，术前腹胀、腹痛症状消失，无复发，工作、生活正常。结论：腹腔镜下结合带线针补片法治疗巨大腹壁切口疝具有损伤小、术后疼痛轻、并发症少、康复快、下床活动早、效果好等优点。 　　【关键词】? 腹壁切口疝；腹腔镜；病例报告 　　Herniorrhaphy of macrosis abdominal wall incisional hernia by abdominal speculum:with a report of 1 case 　　【Abstract】? Ｏbjective:To explore the method and main point about herniorrhaphy of macrosis abdominal wall incisional hernia by abdominal speculum.Methods:An macrosis abdominal wall incisional hernia(size of hernia ring:12cm?5cm)was repaired.by abdominal speculum with fascioled pin and claw in Sep.2004.Results:Operation was successfully and time of operation was only 100 minute.The COMP of pulmonary infection in postoperation was also healed.It was the seventh day to discharge and livelihood was total normal in seven months after postoperation.Conclusions:An macrosis abdominal wall incisional hernia is repaired by abdominal speculum with fascioled pin and claw.It is a perfect method which include few impairment,soreness,COMP and good effect and so on. 　　【Key words】? Abdominal wall incisional hernia;Laparoscopy;Case report ??? 腹腔镜腹股沟疝修补术国内外已积累了大量经验，但腹腔镜切口疝修补术文献尚少。２００４年９月我们在腹腔镜下配合带线针和针钩用补片法修补１例巨大腹壁切口疝，取得了满意效果，现报道如下。 　　1? 资料与方法 　　11? 临床资料? 　　患者女，７２岁。行腹直肌肌皮瓣修复胸部创面术后１８个月，出现腹部肿物１５个月。患者１８个月前，由于前胸部溃疡皮肤大面积缺损，行腹直肌肌皮瓣修复创面。术后切口感染，经治愈后３个月右腹部切口处出现一包块，平卧时或用手推包块可消失。包块越来越大，有时出现腹胀、腹痛，影响工作、生活。体格检查示生命体征正常，胸、右腹部可见手术疤痕，站立时右腹部切口处可见疝囊鼓出，为２１cm×２８cm大，平卧时用手推可回纳腹腔，患者有气紧表现，疝环为１２cm×１５cm大。入院诊断为巨大腹壁切口疝。 　　１２? 手术方法? 　　采用全麻，术前置胃管及尿管。建立气腹（１３～１４mm Hg）后，在疝囊左侧，尽量远离疝环置入腹腔镜，按照三角原理，在适当位置置２～３枚５mm Trocar作操作孔。分离粘连于疝囊的大网膜和肠管，还纳疝内容物，在腹腔镜的引导下于腹壁确定疝环大小并作记号。按照疝环大小剪裁适当大小补片（用戈尔双面补片），要求各方向超过缺损４～５cm，在腹壁疝环投影线上和补片周边上做Ａ、Ｂ、Ｃ、Ｄ、Ｅ、Ｆ ６个对应标记。将补片６个点用不可吸收线打结于粗面，把补片送入腹腔，铺平补片，粗面向上，６个点与疝环投影对应，经戳孔（２mm）用针钩把线引出腹壁外打结后埋于戳孔内，缝合固定覆盖腹壁缺损区，再用带线针和针钩配合缝合５～６针于疝环中间，使补片和腹壁紧贴。然后，用腹腔镜疝钉合器钉合补片于腹壁腱膜上数针加固，并以大网膜覆盖补片，不置引流，解除气腹，粘合切口，术后取半卧位，以利于呼吸