Early Experience with Laparoscopic Incisional Hernia Repair

切口疝氣的腹腔鏡修補術：初期經驗報告

黃其晟(Chi-Cheng Huang) ； 黃清水(Ching-Shui Huang)

《臺灣消化醫學雜誌》 20卷1期 (2003/03) Pp. 1-8

https://doi.org/10.6557/GJT.200303_20(1).0001

摘要

腹壁切口疝氣是腹部手術後常見的併發症，傳統的切口疝氣修補術有很高的再發生率。使用人工網的修補，復姿率雖稍減，但手術及傷口的併發症仍然很高。近年來歐美已有以腹腔鏡手術來修補切口疝氣結果較好之報告。作者兩年來經由腹腔鏡腹膜內雙面人工網置入(Underlay Dualmesh(上標 R) Placment)方式來治療三十七例腹壁切口疝氣病人，其中十二例為復發性疝氣。平均疝氣缺口大小為50.2平方公分，四分之一的病人有多重的疝氣缺口。由於過度沾黏，有一例由腹腔鏡轉換為開腹手術。在術後發生的併發症少而輕微，包括兩例尿滯留，兩例漿液瘤，一例腸阻塞，一例傷口感染及出血。術後住院天數為三至八日（平均四日）。在復發性疝氣的病人中，使用腹腔鏡比起開腹手術，病人有較少的傷口疼痛也較快恢復日常活動。在術後追蹤期間（三到二十一個月，平均九個月），沒有任何一例復發。由以上經驗可知，腹腔鏡切口疝氣修補為一種有效且安全的手術，手術期間的併發症與短期的復發率都非常低，是腹壁切口疝氣治療的新選擇。腹壁切口疝氣的腹腔鏡修補結果優於傳統開腹手術的原因除了一般內視鏡手術的低侵襲性外，還有應用傳統手術所沒有的無張力修補觀念及可放置於腹腔內的人工網，長期的復發率預期較低，但仍需進一步追蹤。

關鍵字

切口疝氣 ； 腹腔鏡修補術 ； 雙面人工網

並列摘要

Conventional incisional hernia repair, even with a piece of mesh incorporated, has high recurrence and morbidity. Laparoscopic incisional hernia repair was reported in western countries to be a better alternative. The purpose of this study is to report the early experiences of laparoscopic incisional hernia repair among Taiwanese patients. Thirty-seven patients with incisional hernia, twelve were recurrent, received laparoscopic underlay Dualmesh(superscript R) (ePTFE) repair at Cathay General Hospital in past two years with one conversion. The mean area of defect was 50.2 cm^2. Multiple defects were found in 13(35%) patients. Peri-operative complications included dysuria (2), seroma (2), ileus (1), trocar site bleeding (1) and wound infection (1). Post-operative hospitalizations ranged from 3 to 8 (mean; 4.3) days. Post-operative patients' questionnaire revealed less pain experienced during laparoscopic repair by those who had previous open repair. There were no recurrences during a 3 to 21 (mean; 9.1) months follow-up. Based on our initial results, laparoscopic incisional hernia repair is safe and feasible among Taiwanese. Comparing to the open repair, laparoscopic incisional hernia repair has less perioperative complications, debility, and short-term recurrence rate. Long-term recurrence is expected to be lower than conventional repair due to less surgical trauma and the tension-free nature of laparoscopic repair.

並列關鍵字

incisional hernia ； laparoscopic repair ； Dualmesh