中国普外基础与临床杂志

中国普外基础与临床杂志

合成补片经会阴修补腹腔镜直肠癌术后会阴疝的诊治体会

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目的 总结利用合成补片经会阴修补腹腔镜直肠癌术后会阴疝的诊治经验。 方法 回顾分析 2009–2015 年期间于笔者所在医院行腹腔镜腹联合会阴直肠癌根治术后发生会阴疝的 4 例患者的临床资料。4 例患者均行合成补片经会阴修补会阴疝及盆底重建手术。 结果 4 例患者术后恢复均顺利,术中出血量为 50~100 mL,手术时间 1.0~1.5 h,术后推迟下床活动时间至术后 5~7 d,术后 10~14 d 出院。所有病例无并发症出现。出院后建议患者长期坚持以 T 型会阴绷带或质硬内裤的方式向上提拉会阴部以减少张力。术后 24 个月随访期间,4 例患者行体格检查以及腹盆腔 CT 扫描未显示会阴疝或肿瘤复发。 结论 利用合成补片经会阴修补会阴疝的创伤相对小,效果较好,对于腹腔镜腹联合会阴直肠癌术后非复杂性会阴疝可优先考虑这种修补方式。

Objective To summarize the surgical experience of perineal hernia (PH) repairment after a laparoscopic abdominoperineal resection (APR) with synthetic mesh. Methods The clinical data of 4 cases of PH after APR from 2009 to 2015 underwent surgery were analyzed retrospectively. We applied synthetic mesh for the reconstruction of the pelvic floor. Results All of the 4 cases recovered smoothly, with no complication happened. The blood loss during the operation was 50–100 mL, the operative time was 1.0–1.5 hours, the postoperative time of getting out of bed was delayed to 5–7 days after the operation and discharged after 10–14 days. Patients were advised to use transperineal bandages or rigid underpants to lift up the perineum to reduce tension after discharge. No recurrence of perineal hernia or the tumor was found on physical examination and abdominal pelvic CT scan during the 24-month follow-up. Conclusions It brings better effect and less trauma after the operation by using transperineal repair of PH with synthetic mesh. We suggest that this technique should probably be the first choice for treating an uncomplicated PH that occurs after a laparoscopic APR.

关键词: 会阴疝; 腹腔镜腹联合会阴直肠癌切除术; 合成补片

Key words: perineal hernia; laparoscopic abdominoperineal resection; synthetic mesh

引用本文: 贺梁, 王江, 李骜, 张永久. 合成补片经会阴修补腹腔镜直肠癌术后会阴疝的诊治体会. 中国普外基础与临床杂志, 2018, 25(12): 1425-1428. doi: 10.7507/1007-9424.201807053 复制

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