[1]刘小慧** 贺曼曼① 谢新宁 冯运章 冯喆②.腹腔镜手术后trocar部位疝12例临床分析[J].中国微创外科杂志,2024,01(2):112-117.
　Liu Xiaohui*,He Manman,Xie Xinning*,et al.Clinical Analysis of 12 Cases of Trocar Site Hernia After Laparoscopic Surgery[J].Chinese Journal of Minimally Invasive Surgery,2024,01(2):112-117.
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腹腔镜手术后trocar部位疝12例临床分析()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2024年2期
页码:
112-117
栏目:
短篇论著
出版日期:
2024-02-25

文章信息/Info

Title:
Clinical Analysis of 12 Cases of Trocar Site Hernia After Laparoscopic Surgery
作者:
刘小慧** 贺曼曼① 谢新宁 冯运章 冯喆②
(邯郸市中心医院普外二科，邯郸056001)
Author(s):
Liu Xiaohui*;  He Manman;  Xie Xinning*;  et al.
*Department of General Surgery Ⅱ, Handan Central Hospital, Handan 056001, China
关键词:
腹腔镜; 疝; 肠梗阻; 肠坏死
Keywords:
Laparoscopy; Hernia; Intestinal obstruction; Intestinal necrosisTrocar
文献标志码:
A
摘要:
目的探讨trocar部位疝(trocar site hernia，TSH)的临床特征、诊治要点及预后。方法回顾性分析2019年1月~2023年1月12例腹腔镜手术后TSH的临床资料。临床表现肠梗阻8例，trocar切口迁延不愈伴渗液1例，无明显症状3例。9例腹部CT诊断，余3例分别通过小肠造影、腹部MRI、腹平片联合腹部彩超诊断。发生于右下腹5例，左下腹4例，右上腹3例。trocar直径12 mm 6例，10 mm 5例，5 mm 1例。trocar部位放置引流管5例。11例行开放性手术，包括小肠还纳、腹壁逐层缝合术4例，小肠部分切除吻合术3例，Onlay修补术3例，部分大网膜切除、横结肠还纳、Onlay修补术1例；另1例trocar部位迁延不愈，拒绝手术，动态观察。结果11例手术顺利，术后1例炎性肠梗阻行小肠减压管置入术，1例切口出血再次急诊手术止血，余恢复顺利。12例均获随访，随访5~48个月，中位13个月，1例未手术者trocar部位仍有硬结伴间断渗液，1例因肿瘤转移死亡，余10例均无疝复发。结论TSH最常见表现为肠梗阻症状，多发生于直径≥10 mm的trocar，如有症状应尽早手术修补。
Abstract:
ObjectiveTo summarize the clinical features, diagnosis and treatment and prognosis of trocar site hernia (TSH).MethodsClinical data of 12 patients with TSH receiving laparoscopic surgery from January 2019 to January 2023 were retrospectively analyzed. The clinical manifestations included intestinal obstruction in 8 cases, trocar incision prolongation with fluid seepage in 1 case, and no obvious symptoms in 3 cases. The patients were diagnosed by abdominal CT in 9 cases, by small intestine contrast imaging in 1 case, by abdominal MRI in 1 case, and by abdominal plain film combined with abdominal color ultrasound in 1 case. The hernia was located in the right lower abdomen in 5 cases, the left lower abdomen in 4 cases, and the right upper abdomen in 3 cases. The trocar diameter was 12 mm in 6 cases, 10 mm in 5 cases, and 5 mm in 1 case. A drainage tube was placed at trocar site in 5 cases. Open operations were performed in 11 cases, including small intestine reduction and abdominal wall layerbylayer suture in 4 cases, partial small intestine resection and anastomosis in 3 cases, Onlay repair in 3 cases, and partial omentectomy, transverse colon reduction and Onlay repair in 1 case. Another case developed trocar site refractoriness which did not heal, and the patient refused surgery, who was given dynamic observation.ResultsThe operation was successful in the 11 cases. Postoperatively, 1 case of inflammatory intestinal obstruction underwent intestinal decompression tube implantation, 1 case of incision bleeding underwent emergency operation again to stop bleeding, and the rest recovered smoothly. All the 12 patients were followed up for 5-48 months, with a median of 13 months. The patient without surgery had persistent induration and intermittent exudation at the trocar site. One case died due to tumor metastasis, and none of the others had hernia recurrence.ConclusionsThe most common manifestation of TSH is intestinal obstruction, which mostly occurs at trocar with diameter ≥ 10 mm. If there are symptoms, it should be treated by surgery as soon as possible.

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备注/Memo

备注/Memo:
基金项目：邯郸市科学技术研究与发展计划项目(21422083140)**通讯作者，Email：liuhui10@163.com ①麻醉科 ②超声医学科
更新日期/Last Update: 2024-05-03