防粘连复合补片腹腔内平铺术治疗腹壁巨大切口疝11例论文.docVIP

防粘连复合补片腹腔内平铺术治疗腹壁巨大切口疝11例临床分析 摘要：目的：探讨应用防粘连复合补片腹腔内平铺术治疗腹壁巨大切口疝的手术方法和临床效果。 方法： 回顾性分析我院11例应用防粘连复合补片腹腔内平铺术治疗腹壁巨大切口疝患者的临床资料。 结果： 11例患者均顺利完成手术，手术时间70～180 min，出血量50～200ml，术后住院时间7～14 d，2例患者术后有皮下积液，经穿刺抽吸治疗后治愈；5例患者术后1～3个月内手术修补区域腹壁疼痛，无其他严重并发症。11例患者术后随访10～26个月，未见复发。结论：应用防粘连复合补片治疗腹壁巨大切口疝是一种安全有效的手术方法，特别是腹腔镜辅助下ipom能减少手术难度，缩短手术时间。 关键词：防粘连复合补片； 切口疝； 疝修补术； ipom abstract：objective： to investigate the methods and clinical results of the intraperitoneal onlay mesh (ipom) repair with antisticking composite mesh for giant abdominal incisional hernia. methods： the clinical data of 11 cases with giant abdominal incisional hernia treated by ipom with antisticking composite mesh in our hospital from july 1992 to oct. 2010 were analyzed retrospectively. ruselts： all the 11 patients got successful operations. the operation time was 70～180 minutes. the bleeding was50~200ml during the operation. hospitalization time after operation was 7～14d. subcutaneous hydrops were observed in 2 pations witch cured by puncture treatment.pain in the abdominal opration area were developed in 5 pations within 1 ~3 months after opration.there was no severe complications in all 11 pations. recurrence was not found with a postoperative follow-up ranged from 10 months to 26 months.conclusions:ipom with antisticking composite mesh for giant abdominal incisional hernia was effective and safe. laparoscopic-assisted ipom can reduce the operative difficulty and shorten the operation time. key words:antisticking composite mesh; incisional hernia,hernioplasty;ipom 【中图分类号】r656.24 【文献标识码】b 【文章编号】1672-3783(2012)06-0186-02 腹壁切口疝是腹部手术后常见并发症，其发生率约为2%～11%[1]。切口疝的修补手术复杂,尤其是对于疝环直径≥10cm的巨大切口疝的修补是一项较为困难的手术[2]。本研究回顾性分析2008年07月～2010年10月河南省人民医院微创外科收治的11例腹壁巨大切口疝患者的临床资料,应用防粘连复合补片腹腔内平铺术(ipom)的修补方法,取得了良好效果,现报道如下。 1 临床资料与方法 1.1 临床资料:本组患者男性6例，女性5例，年龄51～80岁（中位年龄66岁），患者合并症、原手术类型、距上次手术时间、切口疝部位和疝环大小具体见表1。本组切口疝均为初发疝，无复发疝患者。 1.2 方法 1.2.1 术前准备:患者除入院常规检查外，常规行血气分析、肺功能检查以了解呼吸功能；所有患者行腹部侧卧位的ct或mri检查，了解腹壁缺损部位、大小、有无和腹腔内肠管网膜组织粘连，并计算疝囊与腹腔容积比值；术前逐步将疝内