腹腔镜疝修补术的发展和并发症防治

Development of laparoscopic hernia repair and prevention and treatment of complications

  • 摘要: 腹外疝是外科领域的常见病和多发病, 其发病率随着人口老龄化趋势凸显逐年升高,已对人们的生命质量构成威胁。腹腔镜疝修补术是建立在无张力疝修补术基础上的微创手术方式,历经数十年发展,目前已成为治疗腹外疝的主流治疗方法,其中成人腹股沟疝经典手术方式包括腹腔内修补术、经腹腹膜前修补术和全腹膜外修补术。然而,伴随其广泛开展相关并发症的报道亦逐渐增加,其并发症主要包括血管损伤和出血、术后疼痛和神经损伤、血清肿、肠梗阻、感染以及复发等,广大疝外科医师仍需给予足够重视并采取相应防治措施。其中,掌握不同腹腔镜疝修补术的优缺点和适应证,理解各类并发症的发生机理,提高腹腔镜操作技术,熟悉局部解剖结构,规范手术操作等均有助于减少并发症的发生。相信通过建立正确、规范的操作培训体系将能够进一步缩短外科医师的学习曲线,推进我国疝外科的进步和发展。

     

    Abstract: Ventral hernia is a very common surgical problem with its incidence gradually increasing due to aging population, and it has significantly threat to quality of life. Laparoscopic hernia repair is a kind of minimally invasive surgery based on tension free hernia repair, which has become an effective way for treatment of ventral hernia after decades of development. Besides, the classic surgical approaches for adult inguinal hernia include intraperitoneal onlay mesh, transabdo minal peritoneal and totally extraperitoneal repairs. However, some related complications including vascular injury and bleeding, postoperative pain, nerve damage, seroma, intestinal obstruction, infection and relapse have been increasingly reported with the extensive applications of laparoscopic ventral hernia repair. Surgeons still need to pay more attentions and take appropriate measures to prevent such events. Complications could be reduced by strictly following the indications of different laparoscopic hernia repair surgeries with a careful consideration of the advantages and disadvantages, understanding their pathogenesis, improving the laparoscopic operation techniques, getting familiar with the local anatomical structures and standardizing the surgical procedures. Establishing a correct and standard surgical training system will further shorten the learning curve of surgeons to promote the progression and development of hernia surgery in China.

     

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