中国实用外科杂志

中国实用外科杂志

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开放手术联合腹腔镜技术治疗腹壁嵌顿性或绞窄性切口疝11例疗效分析

罗    文，王    勇，段    鑫   

  1. 华中科技大学同济医学院附属武汉市中心医院疝与腹壁外科，湖北武汉 430014
  • 出版日期:2016-05-01 发布日期:2016-04-28

  • Online:2016-05-01 Published:2016-04-28

摘要：

目的    分析开放手术联合腹腔镜技术（杂交手术）修补嵌顿性或绞窄性切口疝的临床疗效。方法    回顾性分析2011年1月至2015年1月华中科技大学同济医学院附属武汉市中心医院疝与腹壁外科采用杂交手术治疗的11例嵌顿性或绞窄性切口疝病人的临床资料，并对病人术后进行随访。结果    所有病人均顺利完成手术，术后未见肠管损伤、心肺衰竭等严重并发症发生。手术时间为80～244（151.9±65.2）min，疝环缺损最大径为3～8（4.5±1.2）cm。10例病人为小肠嵌顿伴肠梗阻，1例病人为肠系膜嵌顿；4例病人术中证实为绞窄性切口疝，术中探查为小肠缺血坏死，体外行坏死小肠切除吻合；术中4例病人发现有隐匿性缺损存在。病人术后排便时间为3～9（4.1±2.2）d，4例病人术后早期出现明显腹胀症状，对症处理2～7 d后缓解。病人术后住院时间为7～18（11.7±3.6）d。术后随访12～36个月，中位随访时间为21个月，均未出现肠梗阻、迟发性补片感染、补片膨出及疝复发等并发症。结论    杂交手术修补嵌顿性或绞窄性切口疝具有一定的优势，值得临床推广应用。

关键词: 切口疝, 嵌顿疝, 开放手术, 腹腔镜技术, 绞窄性

Abstract:

Therapeutic effect of hybrid surgery for incarcerated or strangulated incisional hernia repair：An analysis of 11 cases        LUO Wen，WANG Yong，DUAN Xin. Department of Hernia and Abdominal Surgery，the Central Hospital of Wuhan，Tongji Medical College Huazhong University of Science & Technology，Wuhan 430014，China
Corresponding author：WANG Yong，E-mail：rovine1984@sohu.Com
Abstract    Objective    To investigate the safety and effectiveness of a hybrid technique for incarcerated or strangulated incisional hernia repair. Methods    The clinical and follow-up data of 11 cases of hybrid technique for incarcerated or strangulated incisional hernia repair performed from January 2011 to January 2015 in Department of Hernia and Abdominal Surgery，the Central Hospital of Wuhan，Tongji Medical College Huazhong University of Science & Technology were analyzed retrospectively. Results    All cases were performed by hybrid technique successfully and without complications such as the injury of intestinal canal and cardiopulmonary failure after operations.We completed with a mean operation time of (151.9±65.2) min and found the diameter of the hernial ring of 3～8（4.5±1.2）cm. According to our statistics,10 cases of small bowel incarcerated with intestinal obstruction and 1 case of mesenteric incarcerated.4 cases of actually strangulation incision hernia with the small intestinal ischemic necrosis and were repaired in vitro.In addition,we found 4 cases of the occult hernial defects during the operation. The time of postoperative defecations was 3～9（4.1±2.2）d, and 4 cases of obvious symptoms of postoperative abdominal distension but recovered by treatment after 2 ~ 7d. All patients were followed up for 21(12～36) months. There was neither obvious seroma nor recurrence nor bulging. Conclusion    The hybrid technique is safe and effective for incarcerated incisional hernia repair with less complication.

Key words: incisional hernia, incarcerated hernia, open surgery, laparoscopic technique, strangulated hernia