摘要
复杂腹壁疝是指巨大和(或)合并一系列并发症的腹壁疝,这些并发症均会影响治疗腹壁疝的方案和效果。针对不同类型复杂腹壁疝采用对应的个体化治疗措施防治并发症是合理可行的治疗方案。相关要点包括:巨大腹壁疝,术中借助组织分离技术扩大腹腔容积,部分病例需要切除内容物,行主动减容,术后监测腹压,防治腹腔间室综合征;多发腹壁疝,选择性采用腹腔镜探查避免漏诊隐匿疝,适当缩窄或关闭疝环,采用腹腔内修补术(IPOM)修补多发疝环;嵌顿性或绞窄性腹壁疝,腹腔镜联合开放术式处理疝内容物,应用部分可吸收材料修补,防治术后感染;复发和再发腹壁疝,腹腔镜探查隐匿疝,腹腔内修补疝环;合并感染、肠瘘的腹壁疝,开放清创去除感染灶,应用可吸收性或部分可吸收材料修补缺损,围手术期应用抗生素;特殊位置的腹壁疝(包括边缘腹壁疝),根据疝的位置选择腹腔镜或开放手术修补;合并肝硬化腹水的腹壁疝,围手术期合理药物治疗控制腹水,采用开放手术进行修补;合并腹壁肿瘤的腹壁疝,需要全面评估肿瘤的生物学行为后,先根治肿瘤,再决定疝修补手术方式;合并严重粘连的腹壁疝,需全面了解病史后选取入路和修补方式,避免脏器误损伤;合并脏器脱垂的腹壁疝,需先处理污染的脱垂脏器后再选取耐受感染能力强的可吸收材料行疝修补术。
Complex ventral hernia means that ventral hernia which is huge and(or)combined with a lot of complications that affected the treatment effects and plans in clinic.Individual laparoscopic therapy strategies for complex ventral hernia are rational and feasible to prevent and cure the complications.The key points mainly include as follows:the huge ventral hernia is performed with initiative volume reduction during operation and detect intra-abdominal pressure after operation to prevent abdominal compartment syndrome(ACS);multiple ventral hernia is performed with intraperitoneal onlay mesh technique(IPOM)to repair hernia rings and occult hernia could be found by the laparoscope;the irreducible and incarcerated hernia is performed with hybrid technique(laparoscope combined with open surgery)with partabsorbable meshes to prevent the postoperative infection;the recurrent ventral hernia is also performed with IPOM and occult hernias were detected;the cases of ventral hernia combined with infection and intestinal fistula were performed with debridement by open operation in order to remove infection and part-absorbable meshes are placed to repair the defects,the laparoscope is performed to prevent the the accident injury,antibiotics are applied in perioperative period;the ventral hernia with specific positions(including marginal ventral hernia)are performed with tacks and sutures fixation to ease the difficulty level of mesh fixation,or using open preperitoneal repair technique;it should be decided after the tumor being assessed and treated whether mesh could be use in the ventral hernia with abdominal tumor;surgical approach and method would be decided after a thorough medical history in cased with severe adhesion;the contaminated organ prolapse should be treated and then material with resistance to infection could be use to fix the vantral hernia.
作者
杨硕
陈杰
YANG Shuo;CHEN Jie(Department of Hernia and Abdominal Wall Surgery,Beijing Chao-Yang Hospital,Capital Medical University,Beijing 100043,China)
出处
《中国实用外科杂志》
CAS
CSCD
北大核心
2021年第4期387-391,共5页
Chinese Journal of Practical Surgery
基金
北京市医院管理局临床技术创新项目(No.XMLX201602)。
关键词
复杂腹壁疝
个体化治疗
并发症
腹腔镜
疝修补术
complex ventral hernia
individual laparoscopic therapy
complication
laparoscopy
hernia repair
