本文選題：微創(chuàng)　切入點：腹腔鏡　出處：《中國實用外科雜志》2015年11期 　論文類型：期刊論文

【摘要】：在疝和腹壁外科領(lǐng)域,腹腔鏡疝修補手術(shù)是微創(chuàng)手術(shù)的概念受到了極大的挑戰(zhàn),而且此論點在腹股溝疝和腹壁切口疝的治療上具有明顯的不同。腹腔鏡腹股溝疝修補術(shù)(LIHR)僅應(yīng)視為一種手術(shù)方法,而非微創(chuàng)手術(shù)。LIHR須采用全身麻醉,具有更多的分離、更復(fù)雜的操作、更長的手術(shù)時間,且嚴(yán)重并發(fā)癥發(fā)生率更高;而開放手術(shù)可在局麻下實施,具有更少的分離、更簡單的操作、更短的手術(shù)時間以及更低的嚴(yán)重并發(fā)癥發(fā)生率。雖然LIHR術(shù)后病人相對能更早地恢復(fù)工作,術(shù)后慢性疼痛和切口感染發(fā)生率也相對更低,但其是微創(chuàng)手術(shù)的觀點并未被廣大醫(yī)生所贊同。腹腔鏡切口疝修補術(shù)(LIVH)已被證明是腹壁切口疝病人安全、有效及合理的選擇。LIVH手術(shù)創(chuàng)傷小、手術(shù)時間短,術(shù)后疼痛輕、恢復(fù)快、復(fù)發(fā)率低,而且切口并發(fā)癥和補片感染的發(fā)生率均很低,住院時間及恢復(fù)正常工作生活的時間均明顯縮短,術(shù)后早期生活質(zhì)量明顯高于開放手術(shù)。LIVH應(yīng)成為腹壁切口疝手術(shù)的首選�？傊�,腹腔鏡手術(shù)在腹股溝疝修補手術(shù)中微創(chuàng)的優(yōu)勢不明顯,甚至被認(rèn)為創(chuàng)傷更大,但在腹壁切口疝及其他腹壁疝的治療中優(yōu)勢巨大。
[Abstract]:In the field of herniation and abdominal wall surgery, the concept of laparoscopic herniorrhaphy as a minimally invasive surgery has been greatly challenged. And this argument is significantly different in the treatment of inguinal hernia and incisional hernia. Laparoscopic inguinal herniorrhaphy (LIHRs) should only be considered as a surgical procedure, rather than minimally invasive surgery. LIHR should be treated with general anesthesia, with more separation. More complex operations, longer operating times, and higher incidence of serious complications; open surgery, which can be performed under local anesthesia, with fewer separations and simpler procedures, Shorter duration of surgery and lower incidence of severe complications. Although patients after LIHR return to work relatively early, the incidence of chronic pain and incision infection is also relatively low. However, the viewpoint of minimally invasive operation was not agreed by the majority of doctors. Laparoscopic incisional hernia repair has been proved to be safe for patients with abdominal wall incisional hernia. The effective and reasonable choice of the operation is less trauma, shorter operation time, less postoperative pain and faster recovery. The recurrence rate was low, the incidence of incision complication and patch infection was very low, the time of hospitalization and the time of returning to normal working life were shortened obviously. The quality of life in early postoperative period was significantly higher than that in open operation. Liva should be the first choice of incisional hernia surgery. In a word, the advantage of laparoscopy in inguinal herniorrhaphy is not obvious, even it is considered to be more traumatic. But it has great advantages in the treatment of incisional hernia and other abdominal wall hernia.
【作者單位】： 復(fù)旦大學(xué)附屬華東醫(yī)院普外科;
【分類號】：R656.2

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