Eisenberg Dan, Popescu Wanda M, Duffy Andrew J, Bell Robert L
Department of Surgery, Palo Alto Veterans' Affairs Health Care System, Stanford University School of Medicine, Palo Alto, California 94304, USA.
JSLS. 2008 Jul-Sep;12(3):262-6.
Symptomatic subxiphoid incisional hernias present difficult surgical problems, especially in immuno-suppressed cardiac transplant patients. Here, we describe the laparoscopic repair of subxiphoid incisional hernias in patients with a history of cardiac transplantation.
Four patients with subxiphoid hernias who had previously undergone heart transplantation were identified from a prospective database. Each underwent a laparoscopic repair with mesh implantation.
Three patients had a previous open repair. The mean age was 62.5 years, an average of 64.3 months after transplantation. At the time of surgery, all patients were immunosuppressed, and each had a subxiphoid, poststernotomy incisional hernia. Gore dual mesh was used in 2 patients, while Parietex mesh was used in 2. Mean operative time was 122 minutes, and all were completed laparoscopically. The mean length of stay was 6.5 days, and the mean defect size was 286.25 cm(2). There was a significant correlation between hernia size and length of stay (P=0.037). Postoperatively, one patient (25%) developed pulmonary edema, and 1 patient (25%) had a prolonged ileus.
Symptomatic subxiphoid incisional hernias are a challenging surgical problem in patients with a history of sternotomy. Laparoscopic repair is safe and effective in immunosuppressed patients who have previously undergone cardiac transplantation.
有症状的剑突下切口疝带来了棘手的手术问题，尤其是在免疫抑制的心脏移植患者中。在此，我们描述有心脏移植病史患者剑突下切口疝的腹腔镜修复术。
从一个前瞻性数据库中识别出4例曾接受心脏移植的剑突下疝患者。每例患者均接受了腹腔镜下补片植入修复术。
3例患者曾接受过开放修复术。平均年龄为62.5岁，移植后平均64.3个月。手术时，所有患者均处于免疫抑制状态，且均有剑突下胸骨切开术后切口疝。2例患者使用了戈尔双层补片，2例使用了百达可补片。平均手术时间为122分钟，所有手术均通过腹腔镜完成。平均住院时间为6.5天，平均缺损大小为286.25平方厘米。疝大小与住院时间之间存在显著相关性（P = 0.037）。术后，1例患者（25%）发生肺水肿，1例患者（25%）出现肠梗阻时间延长。
有症状的剑突下切口疝对于有胸骨切开术病史的患者而言是一个具有挑战性的手术问题。腹腔镜修复术对于既往接受过心脏移植的免疫抑制患者是安全有效的。
