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腹腔镜修复腹直肌旁疝和切口疝:我们对150例患者的经验

Laparoscopic repair of ventral and incisional hernias: our experience in 150 patients.

作者信息

Yavuz Nihat, Ipek Turgut, As Abdullah, Kapan Metin, Eyuboglu Erhun, Erguney Sabri

机构信息

Department of General Surgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.

出版信息

J Laparoendosc Adv Surg Tech A. 2005 Dec;15(6):601-5. doi: 10.1089/lap.2005.15.601.

Abstract

BACKGROUND

Incisional hernias develop in 2 to 20% of laparotomy incisions. Approximately 100,000 ventral hernias are operated on each year in the United States. The reported recurrence rates for open repair are 25-52% for primary and 12.5-19% for mesh repair. Compared to the open technique, laparoscopic repair has low rates of complications and recurrence, greater patient acceptance, and shorter hospital stay.

MATERIALS AND METHODS

Between April 1999 and April 2004, we treated 150 patients (111 female, 39 male) with ventral and incisional hernias laparoscopically. Data concerning the age and sex of patients, the location, number, and size of fascial defects, the type of hernias and their contents, the size and type of meshes used in repair, operative time, length of hospital stay, and postoperative complications were collected.

RESULTS

Of the 150 patients, 92 had incisional hernias and 58 had umbilical hernias. Polypropylene was used in 85 cases, dual mesh in 40 cases, and composite mesh in 25 cases. The mean age of the patients was 56.0 years (range, 33-81 years). Mean operative time was 63 minutes (range, 30-125 minutes). Mean postoperative hospital stay was 2.5 days (range, 1-15 days). The postoperative complication rate was 8.6% (seroma, paralytic ileus, small bowel injury, and suture-site neuralgia). The mean follow-up period was 32 months (range, 4-60 months). There was a 3% recurrence rate. Three subileus cases were detected during follow-up.

CONCLUSION

The laparoscopic approach to ventral and incisional hernias is safe, feasible, and a good alternative to the open approach. Our results are comparable with those of other reports in the literature.

摘要

背景

剖腹手术切口疝的发生率为2%至20%。在美国,每年约有10万例腹疝患者接受手术治疗。据报道,开放修补术的原发性复发率为25%至52%,补片修补术的复发率为12.5%至19%。与开放技术相比,腹腔镜修补术并发症和复发率低,患者接受度更高,住院时间更短。

材料与方法

1999年4月至2004年4月,我们采用腹腔镜治疗了150例腹疝和切口疝患者(女性111例,男性39例)。收集了患者的年龄和性别、筋膜缺损的位置、数量和大小、疝的类型及其内容物、修补所用补片的大小和类型、手术时间、住院时间以及术后并发症等数据。

结果

150例患者中,92例为切口疝,58例为脐疝。85例使用聚丙烯补片,40例使用双层补片,25例使用复合补片。患者的平均年龄为56.0岁(范围33至81岁)。平均手术时间为63分钟(范围30至125分钟)。术后平均住院时间为2.5天(范围1至15天)。术后并发症发生率为8.6%(血清肿、麻痹性肠梗阻、小肠损伤和缝线部位神经痛)。平均随访时间为32个月(范围4至60个月)。复发率为3%。随访期间发现3例亚肠梗阻病例。

结论

腹腔镜治疗腹疝和切口疝安全可行,是开放手术的良好替代方法。我们的结果与文献中其他报道相当。

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