新型网片固定方法在腹腔镜切口疝修补术中的应用
1Department of Gastroenterological Surgery and Hernia Center, The Sixth Affiliated Hospital, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangzhou,Sun Yat-sen University, 2Department of Gastrointestinal Surgery,the Third Affiliated Hospital of Zunyi Medical University (The First People’s Hospital of Zunyi)
Summary
这里介绍的是一种改善腹腔镜切口疝修补术中补片放置的方法，该方法可以缩短补片固定所需的时间，减少术后慢性疼痛的发生。
Abstract
使用腹腔内嵌体网片（IPOM）的腹腔镜切口疝修补术是修复切口疝气最广泛使用的微创方法之一。腹腔镜IPOM涉及通过腹腔镜将网片植入腹腔以修复腹壁疝。在IPOM手术中，在闭合疝环后，在腹腔镜下放置抗粘连网。该网片的正确放置对于该方法的成功至关重要，并且需要手术技能才能实现完美放置。如果网片放置不当，手术和麻醉时间就会延长。此外，网片放置不当会导致严重后果，如肠梗阻和网片感染。该文描述了一种“对位对齐”的网片固定方法，该方法涉及预先标记网片的固定位置以降低网片放置的难度。正确放置的网片在腹膜上完全平坦，边缘不卷曲或缠绕，并且网片牢固地粘附，以便在去除气腹压力后不会移位。与其他技术相比，“对位和对准”网片固定技术具有网片放置可靠、并发症更少的优点，并且易于学习和掌握。它还允许根据切口疝气的解剖结构提前定位射钉枪。这使得使用尽可能少的钉子，同时仍然确保良好的固定，这可以减少并发症的发生并降低手术成本。因此，基于上述优点，这里描述的网片固定方法非常适合临床应用。
Introduction
切口疝是腹部手术后常见的并发症，只能通过手术进行适当治疗1.与传统的开切口疝相比，腹腔镜疝具有手术创伤少、感染率低、术后恢复快等优点2，3。目前，如果没有禁忌症，腹腔镜疝气是治疗切口疝的首选方法4。
然而，腹腔镜疝在技术上很复杂。腹腔内嵌网（IPOM）通常用于腹腔镜切口疝修补术，这涉及在腹腔镜下将网片放入腹腔以覆盖疝气缺损5。该网片是一种新型的中等重量单丝聚丙烯网，内脏侧覆盖有水凝胶屏障6。对于使用IPOM方法的腹腔镜切口疝修补术，需要掌握穿刺器的放置，分离腹内粘连的技术，缝合切口疝的技术以及将网片放置在腹腔中的方法。特别是，如果网状物没有正确放置和固定，这可能导致疝气复发，以及潜在的严重并发症，例如肠梗阻和网片感染7，8。因此，掌握正确的网片固定技术是取得良好手术效果的重要标准。
切口疝的传统网片固定方法是用双环疝气钉固定网片。将网片放入腹腔后，先用射钉枪固定网片边缘，再固定疝环边缘9.但该方法空间定位较差，网片易发生位移，导致疝气复发。通过对各种网片固定方法的回顾和分析，提出一种新的“对位和对齐”的网片固定方法，并在本协议10中提出。在这种方法中，预先测量切口疝的大小和范围，然后可以预先标记网状固定点。当在手术过程中将网片放入腹腔时，可以根据先前标记的位置进行钉枪固定和缝合固定。这种方法可以降低手术难度、手术时间、医疗费用和并发症的发生。本研究将这种新方法与传统使用的双环疝气钉固定方法进行比较，用于腹腔镜切口疝修补手术中的网状固定。
Protocol
该协议是根据《赫尔辛基宣言》的原则执行的，并经中山大学附属第六医院伦理审查委员会批准。 告知患者和家属拍摄和制作手术视频的目的，并征得知情同意。 1. 患者数据和分组 注：2018年1月至2020年6月，在中山大学附属第六医院进行胃肠道、疝气、腹部手术，采用IPOM方法进行腹腔镜切口疝修补术。在获得知情同意后?…
Representative Results
对研究中的患者进行“对位对齐”网片固定（实验组）或传统双环疝气甲固定术（对照组），每组42例。 在本研究中进行的疝气修复手术期间，在缝合疝环后放置抗粘连网。在实验组中，采用“对位对齐”方法放置网片，而对照组采用传统的双环固定法放置网片。 该协议的第 3 部分详细介绍了具体的网格放置方法（图 1、图 <strong cl…
Discussion
腹腔镜切口疝修补术主要使用IPOM方法5进行，其中网片的放置和固定是获得良好结果的关键。如果网片的放置和固定不当，网片将无法紧紧粘附在腹壁上，并且可能会起皱或移位。网片固定不当与血清肿形成、腹部感染、慢性疼痛和疝气复发有关。具体来说，网状感染的治疗包括穿刺和引流。与网片感染相关的术后疼痛通常保守治疗，治疗不良可能需要进一步手术切除部分或全?…
Divulgazioni
The authors have nothing to disclose.
Acknowledgements
本研究得到了广东省科技计划项目（批准号：2021A1515410004）和国家临床重点学科（批准号：[2012]649）的支持。
Materials
| 1-0 Stratafix Symmetric PDS Plus Violet 45cm PS-1 | ETHICON | sxpp1a401 | STRATAFIX Symmetric PDS Plus |
| 3-0 VICRYL suture | ETHICON | VCP316 | absorbable suture |
| AbsorbaTack Fixation | Covidien llc | ABSTACK15 | absorbable nail gun |
| Laparoscopic needle holder | KARL-STORZ | 26173KL | needle holder |
| Laparoscopic separating forceps | KARL-STORZ | 38651ON | separating forceps |
| Laparoscopic system (OTV-S400) | Olympus | CLV-S400_WA4KL530 | 4K HD image large screen surgical laparoscope |
| ProTack Fixation | Covidien llc | 174005 | Non absorbable nail gun |
| VENTRALIGHT ST | BARD | 5954810 | Biological anti-adhesion mesh |
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Citazione di questo articolo
Ma, N., Tang, D., Tang, F., Huang, E., Ma, T., Yang, W., Liu, C., Huang, H., Chen, S., Zhou, T. Application of a New Mesh Fixation Method in Laparoscopic Incisional Hernia Repair. J. Vis. Exp. (190), e64916, doi:10.3791/64916 (2022).