Tonouchi Hitoshi, Ohmori Yukinari, Kobayashi Minako, Kusunoki Masato
Departments of Innovative Surgery, Mie University School of Medicine, Mie, Japan.
Arch Surg. 2004 Nov;139(11):1248-56. doi: 10.1001/archsurg.139.11.1248.
To review the relationship between the pathogenesis and clinical manifestations of trocar site hernias seeking to confirm the definition of trocar site hernias by classification.
We searched this subject in English on MEDLINE by combining the words "trocar," "port," "hernia, and "laparoscopy."Data Extraction and
We limited the main operations to cholecystectomy, colon and rectal surgery, fundoplication, and gastric surgery; finding 44 reports on these procedures. Of these, 19 were case reports, 18 were original articles (setting criteria; the incidence of the trocar site hernia was clarified, and involved >100 patients), and 7 technical notes on "how to do it" were collected. We obtained 19 additional reports using the references of those previously obtained. We, thus, reviewed 63 reports (24 case reports, 27 original articles, 7 technical notes, and 5 review articles).
Trocar site hernia was classified into 3 types. The early-onset type that occurred immediately after the operation, with a small-bowel obstruction, especially the Richter hernia, frequently developing. The late-onset type that occurred several months after the operation, mostly with local abdominal bulging with no small-bowel obstruction developing. The special type that occurred indicated the protrusion of the intestine and/or omentum. Trocar site hernias with fascial defects of 10 mm or larger should be closed, including the peritoneum. Opinion varied if a 5-mm trocar site defect should be closed.
It is useful to clearly classify trocar site hernias to improve management of laparoscopic procedures.
回顾套管针穿刺部位疝的发病机制与临床表现之间的关系，试图通过分类来明确套管针穿刺部位疝的定义。
我们通过在MEDLINE上用英文搜索“套管针”“穿刺孔”“疝”和“腹腔镜检查”等关键词来检索该主题。
我们将主要手术限定为胆囊切除术、结肠和直肠手术、胃底折叠术和胃部手术；共找到44篇关于这些手术的报告。其中，19篇为病例报告，18篇为原创文章（设定标准；明确了套管针穿刺部位疝的发生率，且涉及患者超过100例），还收集了7篇关于“如何操作”的技术说明。我们利用先前获得的文献的参考文献又获取了19篇报告。因此，我们回顾了63篇报告（24篇病例报告、27篇原创文章、7篇技术说明和5篇综述文章）。
套管针穿刺部位疝分为3种类型。术后立即发生的早发型，常发生小肠梗阻，尤其是里脱型疝。术后数月发生的迟发型，大多表现为局部腹部隆起，无小肠梗阻。特殊型表现为肠管和/或网膜突出。筋膜缺损10mm或更大的套管针穿刺部位疝应予以关闭，包括腹膜。对于5mm的套管针穿刺部位缺损是否应关闭，意见不一。
明确套管针穿刺部位疝的分类有助于改善腹腔镜手术的管理。
