腹膜前修补手术治疗老年原发性腰疝21例分析
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摘要
目的探讨腹膜前修补术治疗老年原发性腰疝的安全性和有效性。方法回顾性分析首都医科大学附属北京朝阳医院2015年1月至2018年3月行腹膜前疝修补手术治疗21例老年原发性腰疝病人的相关临床资料。结果 21例病人均顺利完成手术,疝环直径为1.5~3.0 cm,平均(2.4±0.4)cm;手术时间为25~75 min,平均(43.4±13.2)min;术后住院时间1~5 d,平均(3.0±1.0)d;术后24h疼痛视觉模拟评分(VAS)2~6分,平均(2.6±0.9)分;术后未出现切口感染及其他严重并发症。21例病人均获随访,术后随访时间2~37个月,平均(18.6±11.3)个月,均无术后慢性疼痛及异物感,无复发病人。结论短期疗效显示,老年原发性腰疝采用腹膜前修补治疗是一种安全可行的手术方式。远期疗效还有待进一步观察。
Objective To explore the safety and effectiveness of sublay herniorrhaphy for elderly primary lumbar hernia.Methods The clinical data of 21 patients with elderly primary lumbar hernia underwent sublay herniorrhaphy between January 2015 to March 2018 in Beijing Chao-Yang Hospital of Capital Medical University were analyzed retrospectively.Results Operations were completed successfully in all 21 cases.The mean lumbar defect was(2.4±0.4)centimeter(range 1.5-3.0 centimeter). The mean operation time was(43.4±13.2) minutes(range 25 to 75) and the mean hospital stay was(3.0±1.0) days(range1-5 days). The postoperative visual analogue scale(VAS) pain score was(2.6±0.9)scores(range 2-6 scores). There were no complication such as incision infection. All cases were followed up for 18.6±11.3 months(2-37) without obvious chronic pain, foreign body sensation and recurrence. Conclusion The Sublay herniorrhaphy in elderly primary lumbar hernia by using the preperitoneal patch is safe and feasible. Its efficacy in shortterm is certain. The long term effect remains to be further observed.
Objective To explore the safety and effectiveness of sublay herniorrhaphy for elderly primary lumbar hernia.Methods The clinical data of 21 patients with elderly primary lumbar hernia underwent sublay herniorrhaphy between January 2015 to March 2018 in Beijing Chao-Yang Hospital of Capital Medical University were analyzed retrospectively.Results Operations were completed successfully in all 21 cases.The mean lumbar defect was(2.4±0.4)centimeter(range 1.5-3.0 centimeter). The mean operation time was(43.4±13.2) minutes(range 25 to 75) and the mean hospital stay was(3.0±1.0) days(range1-5 days). The postoperative visual analogue scale(VAS) pain score was(2.6±0.9)scores(range 2-6 scores). There were no complication such as incision infection. All cases were followed up for 18.6±11.3 months(2-37) without obvious chronic pain, foreign body sensation and recurrence. Conclusion The Sublay herniorrhaphy in elderly primary lumbar hernia by using the preperitoneal patch is safe and feasible. Its efficacy in shortterm is certain. The long term effect remains to be further observed.
引文
[1]陈鑫,李健文,孙晶,等.经腹部分腹膜外修补术治疗腰疝12例临床研究[J].中国实用外科杂志,2014,34(5):426-428.
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[4] Maeda K, Kanehira E, Shinno H, et al. Laparoscopic tension free hernioplasty for lumbar hernia[J]. Surg Endosc,2003,17(9):1497.
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[8]刘素君,陈杰,杨硕,等.小切口Stoppa修补术治疗老年性腰疝18例分析[J].中国现代手术学杂志,2010,14(4):260-262.
[9]戎世捧,田文,刘飞德,等.应用自粘式补片修补腰疝七例[J].中华普通外科杂志,2016,31(7):604-605.
[10]林荣贵,黄鹤光,陈燕昌,等.腹膜后间隙无张力修补治疗腰疝7例临床分析[J].中国实用外科杂志,2017,37(2):182-185.
[11] Moreno-Egea A,Alcaraz AC,Cuervo MC. Surgical options in lumbar hernia:laparoscopic versus open repair. A long-term prospective study[J].Surg Innov,2013,20(4):331-344.
[12]孙桂森,张志斌,顾建华,等.腰疝的诊治及手术体会[J].中华疝和腹壁外科杂志(电子版),2011,5(4):505-509.
[13]李宗倍,王刚,孙备,等.三明治法修补左侧腰疝1例报告[J].中国实用外科杂志,2015,35(5):573.
[14] Burick AJ,Parascandola SA.Laparoscopic repair of a traumatic lumbar hernia:a case report[J].J Laparoendosc Surg,1996,6(4):259-262.
[15] Lim MS,Lee HW, Yu CH, et al.Laparoscopic total extraperitoneal repair of lumbar hernia[J].J Korean Surg Soc,2011,81(4):287-290.
[16] Sun J,Chen X,Li J,et al. Implementation of the trans-abdominal partial extra-peritoneal(TAPE)technique in laparoscopic lumbar hernia repair[J]. BMC Surg,2015,15:118-122.
[17] Walgamage TB, Ramesh BS, Alsawafi Y. Case report and review of lumbar hernia[J]. Int J Surg Case Rep, 2015,6C(1):230-232.
[18] Suarez S, Hernandez JD. Laparoscopic repair of a lumbar hernia:report of a case and extensive review of the literature[J].Surg Endosc, 2013, 27(9):3421-3429.
[2]杜华栋,申英末,孙立,等.腹膜前补片修补术治疗原发性腰疝20例分析[J].中华疝和腹壁外科杂志(电子版),2017,11(5):329-332.
[3]罗坤,庞明辉,侯能易,等.腰疝的临床与治疗研究进展[J].中华疝和腹壁外科杂志(电子版),2015,9(1):78-79.
[4] Maeda K, Kanehira E, Shinno H, et al. Laparoscopic tension free hernioplasty for lumbar hernia[J]. Surg Endosc,2003,17(9):1497.
[5]吴建国,方国恩,罗天航.腰疝9例临床诊治分析[J].中国实用外科杂志,2008,28(7):564-566.
[6] Loukas M, Tubbs RS, El-Sedfy A, et al. The clinical anatomy of the triangle of Petit[J].Hernia,2007,11(5):441-444.
[7] Bathla L, Davies E, Fitzgibbons RJ Jr, et al. Timing of traumatic lumbar hernia repair:is delayed repair safe? Report of two cases and review of the literature[J]. Hernia,2011,15(2):205-209.
[8]刘素君,陈杰,杨硕,等.小切口Stoppa修补术治疗老年性腰疝18例分析[J].中国现代手术学杂志,2010,14(4):260-262.
[9]戎世捧,田文,刘飞德,等.应用自粘式补片修补腰疝七例[J].中华普通外科杂志,2016,31(7):604-605.
[10]林荣贵,黄鹤光,陈燕昌,等.腹膜后间隙无张力修补治疗腰疝7例临床分析[J].中国实用外科杂志,2017,37(2):182-185.
[11] Moreno-Egea A,Alcaraz AC,Cuervo MC. Surgical options in lumbar hernia:laparoscopic versus open repair. A long-term prospective study[J].Surg Innov,2013,20(4):331-344.
[12]孙桂森,张志斌,顾建华,等.腰疝的诊治及手术体会[J].中华疝和腹壁外科杂志(电子版),2011,5(4):505-509.
[13]李宗倍,王刚,孙备,等.三明治法修补左侧腰疝1例报告[J].中国实用外科杂志,2015,35(5):573.
[14] Burick AJ,Parascandola SA.Laparoscopic repair of a traumatic lumbar hernia:a case report[J].J Laparoendosc Surg,1996,6(4):259-262.
[15] Lim MS,Lee HW, Yu CH, et al.Laparoscopic total extraperitoneal repair of lumbar hernia[J].J Korean Surg Soc,2011,81(4):287-290.
[16] Sun J,Chen X,Li J,et al. Implementation of the trans-abdominal partial extra-peritoneal(TAPE)technique in laparoscopic lumbar hernia repair[J]. BMC Surg,2015,15:118-122.
[17] Walgamage TB, Ramesh BS, Alsawafi Y. Case report and review of lumbar hernia[J]. Int J Surg Case Rep, 2015,6C(1):230-232.
[18] Suarez S, Hernandez JD. Laparoscopic repair of a lumbar hernia:report of a case and extensive review of the literature[J].Surg Endosc, 2013, 27(9):3421-3429.