腹膜后间隙无张力修补治疗腰疝7例临床分析

摘要

目的 探讨使用Kugel补片经腹膜后间隙无张力修补治疗腰疝7例的临床经验.方法 回顾性分析福建医科大学附属协和医院基本外科2008年12月至2015年12月收治的7例腰疝使用Kugel补片经腹膜后间隙施行腰疝无张力修补术病人资料.术后通过门诊或电话随访,随访时间截至2016年6月,总结临床经验及术后并发症的情况.结果 7例均在全麻下顺利完成手术,使用11 cm×14 cm的Kugel补片5例,14 cm×17 cm的Kugel补片2例,术中均利用悬吊技术固定补片.平均手术时间65.2 min,平均出血量45.5 mL.常规于补片前留置闭式负压球引流,平均拔除时间3.6 d.术后不受麻醉限制即可下床活动,6 h后恢复半流质饮食,腹带加压束缚3个月,术后平均住院2.8 d.术后随访6~78个月(平均随访时间32.7个月).1例为复发性腰疝,取出原修补补片后再行修补.1例合并同侧腹股沟疝,术中一并修补.1例合并腰部囊肿,术中一并切除.术后无血清肿、血肿、复发、切口感染、慢性疼痛、异物感等并发症.结论 使用Kugel补片经腹膜后间隙行腰疝无张力修补,并采用悬吊技术固定补片,修补牢靠,术后并发症少,恢复快,临床效果好.%Objective To evaluate the clinical experience of lumbar hernia tension-free repair with a Kugel patch through retroperitoneal space. Methods The clinical data of 7 cases of lumbar hernia tension-free repair with a Kugel patch through retroperitoneal space performed from December, 2008 to December, 2015 in Department of General Surgery, Union Hospital, Fujian Medical University were analyzed retrospectively. Follow-up was performed through outpatient service or telephone interview till June, 2016. Postoperative complications were summarized and the clinical effectiveness of the procedure was analyzed. Results Seven cases underwent lumbar hernia repair smoothly under general anesthesia, 5 cases with a 11 cm×14 cm Kugel patch and 2 cases with a 14 cm×17 cm one. Transfixing stitches were adapted in order to ensure the positioning of the mesh. The mean operative time was 65.2 min. Mean blood loss was 45.5 mL. A closed drainage tube was routinely placed in front of the patch with a mean removal time of 3.6 days. Early ambulation was encouraged with no limit to anesthesia. A semi-liquid diet was then restored 6 hours after the operation and pressure dressing was routinely adapted till 3 months after the operation. The mean length of postoperative hospitalization was 2.8 days. All patients were followed up for 6 to 78 months (average 32.7 months). A previous mesh was removed in a recurrent lumbar hernia before repair. An ipsilateral inguinal indirect hernia was repaired with Kugel procedure, and an ipsilateral lumbar cyst with the hernia was resected during the operation. No postoperative complication occurred, including seroma, hematoma, recurrence, incisional infection, chronic pain, and foreign body sensation. Conclusion Lumbar hernia tension-free repair with a Kugel patch through retroperitoneal space, adapting transfixing stitches for fixation, is a safe and useful technique, which is associated with effective repair, few postoperative complications, rapid recovery and good clinical results.