【作者】 李宇洲； 李文滨； 梁健升； 杨庆堂； 姚干；

【Author】 LI Yu - zhou, LI Wen - bin, LIANG Jian - sheng, YANG Qing - tang, YAO Gan(Laparoscopic Hernia Treatment Center, the First People’s Hospital of Foshan, Foshan,Guangdong 528000, P. R. China; Department of General Surgery, the Second AffiliatedPeople’s Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510120, P. RChina)

【机构】 广东省佛山市第一人民医院疝治疗中心； 中山大学附属第二人民医院普外科；

【摘要】 目的腹腔镜腹腔内补片植入术(IPOM),因有补片引起腹内组织粘连引发肠梗阻甚至复发等报道,目前争议较多,未能推广应用。作者改进了以上方法的多个步骤以克服该方法的不足,探讨改进后的方法在成人疝修补中的应用价值。方法以缝合小儿疝的方法关闭内环口;把补片的中心固定在疝环口的中心;经腹壁用可吸收线代替钉合枪以针织的方法把补片四周牢牢地固定并展平紧贴在腹膜上。利用脐内侧韧带腹膜覆盖网片的内侧:减少网片外露的面积,减少粘连发生。结果具有容易与腹膜相融合特性的网片能很快地与腹膜融合成一柔韧性组织,加强了疝环薄弱区,极少引起腹内肠管的粘连,更没有肠梗阻的发生,复发率低。结论作者认为经过改进后的IPOM方法是一种效果确切、创伤少、并发症少、费用低,有微创优点,值得继续探索应用。更多还原

【Abstract】 [Objective] To utilize the suture method which we have rather good effects in laparoscopoic hernioplastyin IPOM to conquer the short -comings of traditional IPOM. [Methods] To close the hernia sac in the suture method we applied in laparoscopic hemioplasty in infants and children; We make the center of the mesh localized in the center of hernia neck; We utilized the lift - insert suture method for the laparoscopic hemioplasty in infants and children to extent and localize the Mesh; cover the medial half mesh with the internal umbilical ligment in order to reduce the explosure of the mesh so as to decrease the incidence of inheresion. [ Results] The Mesh infuse with the peritoneal to strengthen the weakness area. There is no postoperative adherence and the recurrence rate is less than 1 %. [Conclusions] The improved IPOM utilizing the lift - insert suture method has ideal clinical effect and it is a method of less damage, less postoperative complicationamd speedier recovery. It is worthy to be populized.更多还原