疝和腹壁外科微创手术新认识

发布时间：2018-03-08 05:04

本文选题：微创　切入点：腹腔镜　出处：《中国实用外科杂志》2015年11期 　论文类型：期刊论文

【摘要】：在疝和腹壁外科领域,腹腔镜疝修补手术是微创手术的概念受到了极大的挑战,而且此论点在腹股沟疝和腹壁切口疝的治疗上具有明显的不同。腹腔镜腹股沟疝修补术(LIHR)仅应视为一种手术方法,而非微创手术。LIHR须采用全身麻醉,具有更多的分离、更复杂的操作、更长的手术时间,且严重并发症发生率更高;而开放手术可在局麻下实施,具有更少的分离、更简单的操作、更短的手术时间以及更低的严重并发症发生率。虽然LIHR术后病人相对能更早地恢复工作,术后慢性疼痛和切口感染发生率也相对更低,但其是微创手术的观点并未被广大医生所赞同。腹腔镜切口疝修补术(LIVH)已被证明是腹壁切口疝病人安全、有效及合理的选择。LIVH手术创伤小、手术时间短,术后疼痛轻、恢复快、复发率低,而且切口并发症和补片感染的发生率均很低,住院时间及恢复正常工作生活的时间均明显缩短,术后早期生活质量明显高于开放手术。LIVH应成为腹壁切口疝手术的首选。总之,腹腔镜手术在腹股沟疝修补手术中微创的优势不明显,甚至被认为创伤更大,但在腹壁切口疝及其他腹壁疝的治疗中优势巨大。
[Abstract]:In the field of herniation and abdominal wall surgery, the concept of laparoscopic herniorrhaphy as a minimally invasive surgery has been greatly challenged. And this argument is significantly different in the treatment of inguinal hernia and incisional hernia. Laparoscopic inguinal herniorrhaphy (LIHRs) should only be considered as a surgical procedure, rather than minimally invasive surgery. LIHR should be treated with general anesthesia, with more separation. More complex operations, longer operating times, and higher incidence of serious complications; open surgery, which can be performed under local anesthesia, with fewer separations and simpler procedures, Shorter duration of surgery and lower incidence of severe complications. Although patients after LIHR return to work relatively early, the incidence of chronic pain and incision infection is also relatively low. However, the viewpoint of minimally invasive operation was not agreed by the majority of doctors. Laparoscopic incisional hernia repair has been proved to be safe for patients with abdominal wall incisional hernia. The effective and reasonable choice of the operation is less trauma, shorter operation time, less postoperative pain and faster recovery. The recurrence rate was low, the incidence of incision complication and patch infection was very low, the time of hospitalization and the time of returning to normal working life were shortened obviously. The quality of life in early postoperative period was significantly higher than that in open operation. Liva should be the first choice of incisional hernia surgery. In a word, the advantage of laparoscopy in inguinal herniorrhaphy is not obvious, even it is considered to be more traumatic. But it has great advantages in the treatment of incisional hernia and other abdominal wall hernia.
【作者单位】：复旦大学附属华东医院普外科;
【分类号】：R656.2

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