肝膽胰術后切口疝診療優化：單中心18例經驗_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

梅競豪 ¹ , 林凱 ² , 羅凡 ² ,  楊春 ²

1. ;
2. ;

Corresponding?author：

楊春, Email: yang111chun@163.com

Keywords：

切口疝; 肝膽胰手術; 圍術期管理; 個體化

DOI：

10.7507/1007-9424.202508097

Video：

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目的探討肝膽胰開放手術后切口疝的臨床特征，并評估個體化手術修補策略的安全性與療效。方法回顧性分析2023年1月至2025年5月期間于四川省醫學科學院·四川省人民醫院胃腸外科接受無張力疝修補術的18例肝膽胰開放術后切口疝患者的臨床資料。結果 18例患者中，12例行腹腔鏡手術，4例行開放手術，2例行雜交手術。中位手術時間為127.5（95.0，180）min，術中出血量為15.0（10.0，42.5）mL。手術時間與腹腔嚴重粘連（U=12.00，P=0.012）、存在多處缺損（即同一手術切口區域內存在≥2個獨立的腹壁缺損；U=11.50，P=0.018）呈正相關。術后1周發生早期并發癥3例，分別為切口感染、不完全性腸梗阻及急性疼痛各1例，以上患者經保守治療后均痊愈。所有患者均獲得隨訪，隨訪時間3～28個月，無復發及遠期并發癥發生。結論肝膽胰開放術后切口疝多存在復雜解剖特征，以腹腔內補片修補術為主的個體化修補策略安全可行，配合精細化的圍術期管理可取得良好治療效果。

1.	Deerenberg EB, Timmermans L, Hogerzeil DP, et al. A systematic review of the surgical treatment of large incisional hernia. Hernia, 2015, 19(1): 89-101.
2.	中華醫學會外科學分會疝與腹壁外科學組, 中國醫師協會外科醫師分會疝和腹壁外科專家工作組. 腹壁切口疝診療指南 (2024版). 中國實用外科雜志, 2025, 45(2): 128-136.
3.	Iida H, Tani M, Hirokawa F, et al. Risk factors for incisional hernia according to different wound sites after open hepatectomy using combinations of vertical and horizontal incisions: a multicenter cohort study. Ann Gastroenterol Surg, 2021, 5(5): 701-710.
4.	Davey S, Rajaretnem N, Harji D, et al. Incisional hernia formation in hepatobiliary surgery using transverse and hybrid incisions: a systematic review and meta-analysis. Ann R Coll Surg Engl, 2020, 102(9): 663-671.
5.	Togo S, Nagano Y, Masumoto C, et al. Outcome of and risk factors for incisional hernia after partial hepatectomy. J Gastrointest Surg, 2008, 12(6): 1115-1120.
6.	黃永剛, 葉靜, 金華, 等. 肝膽胰手術后切口疝修補術的難點與進展. 中華消化外科雜志, 2022, 21(9): 1234-1239.
7.	Stamer UM, Ehrler M, Lehmann T, et al. Pain-related functional interference in patients with chronic neuropathic postsurgical pain: an analysis of registry data. Pain, 2019, 160(8): 1856-1865.
8.	Chen-Xu J, Bessa-Melo R, Gra?a L, et al. Incisional hernia in hepatobiliary and pancreatic surgery: incidence and risk factors. Hernia, 2019, 23(1): 67-79.
9.	Cheema F, Andacoglu O, Huang LC, et al. Risk factors for surgical site occurrence or infection and recurrence after incisional hernia repair in abdominal transplant population. Transplant Proc, 2021, 53(2): 762-767.
10.	陳雙, 周太成. 多維度解析腹壁疝復發機制及治療策略. 中國實用外科雜志, 2025, 45(5): 501-503.
11.	Bittner R, Bain K, Bansal VK, et al. Update of Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias (International Endohernia Society (IEHS))-Part A. Surg Endosc, 2019, 33(10): 3069-3139.
12.	李航宇. 從生物力學角度重新解讀腹壁重建. 中國實用外科雜志, 2021, 41(4): 379-383.
13.	Scheuerlein H, Rauchfuss F, Gharbi A, et al. Laparoscopic incisional hernia repair after solid-organ transplantation. Transplant Proc, 2011, 43(5): 1783-1789.
14.	Kuo SC, Lin CC, Elsarawy A, et al. Laparoscopic Repair of Incisional Hernia Following Liver Transplantation-Early Experience of a Single Institution in Taiwan. Transplant Proc, 2017, 49(8): 1870-1874.
15.	Gianchandani R, Moneva E, Marrero P, et al. Feasibility and effectiveness of laparoscopic incisional hernia repair after liver transplantation. Transplant Proc, 2011, 43(3): 742-744.
16.	劉亦婷, 申英末. 腹腔鏡修補手術在肝移植術后切口疝的應用及其效果評估. 中華疝和腹壁外科雜志(電子版), 2025, 19(2): 202-205.
17.	符常波, 汪群, 段傳宜, 等. 腹腔鏡聯合開腹補片修補術對巨大切口疝及腸黏連緊密腹壁切口疝患者臨床研究. 中華疝和腹壁外科雜志 (電子版), 2020, 14(1): 55-58.
18.	陳亞柯, 陳建民, 王殿琢, 等. 3種不同層次間放置補片治療腹壁疝的臨床療效. 中國普外基礎與臨床雜志, 2021, 28(1): 38-42.
19.	Bellido-Luque J, Alpizar O, Gomez Rosado JC, et al. Minimally invasive endoscopic retromuscular technique with transversus abdominis release associated (eTEP-TAR) for right subcostal incisional hernias improves postoperative results when compared to conventional laparoscopic incisional hernia repair: a case-control study. Hernia, 2024, 29(1): 34. doi: 10.1007/s10029-024-03186-7.
20.	江志鵬, 周太成, 曾兵, 等. 一種切口疝縫合的創新技術——“立體”縫合. 中國實用外科雜志, 2021, 41(2): 160-163.
21.	馬寧, 湯福鑫, 黃恩民, 等. “對位對線”補片固定法在腹腔鏡切口疝修補術中的應用. 中國普通外科雜志, 2022, 31(4): 474-480.
22.	夏建福, 袁航, 陳浩, 等. 三維打印技術在腹部外科的應用與局限性. 腹腔鏡外科雜志, 2021, 26(5): 388-391.
23.	楊榮鐸, 李紹春, 孟云瀟, 等. 應用CT三維重建技術評估肥胖對切口疝修補術后腹壁功能恢復及疝復發影響研究. 中國實用外科雜志, 2025, 45(4): 457-460.
24.	彭雪峰, 楊華, 李慧, 等. 三維可視化技術在復雜腹壁切口疝中的應用: 48例患者的臨床經驗總結. 中國普外基礎與臨床雜志, 2024, 31(8): 928-932.

1. Deerenberg EB, Timmermans L, Hogerzeil DP, et al. A systematic review of the surgical treatment of large incisional hernia. Hernia, 2015, 19(1): 89-101.
2. 中華醫學會外科學分會疝與腹壁外科學組, 中國醫師協會外科醫師分會疝和腹壁外科專家工作組. 腹壁切口疝診療指南 (2024版). 中國實用外科雜志, 2025, 45(2): 128-136.
3. Iida H, Tani M, Hirokawa F, et al. Risk factors for incisional hernia according to different wound sites after open hepatectomy using combinations of vertical and horizontal incisions: a multicenter cohort study. Ann Gastroenterol Surg, 2021, 5(5): 701-710.
4. Davey S, Rajaretnem N, Harji D, et al. Incisional hernia formation in hepatobiliary surgery using transverse and hybrid incisions: a systematic review and meta-analysis. Ann R Coll Surg Engl, 2020, 102(9): 663-671.
5. Togo S, Nagano Y, Masumoto C, et al. Outcome of and risk factors for incisional hernia after partial hepatectomy. J Gastrointest Surg, 2008, 12(6): 1115-1120.
6. 黃永剛, 葉靜, 金華, 等. 肝膽胰手術后切口疝修補術的難點與進展. 中華消化外科雜志, 2022, 21(9): 1234-1239.
7. Stamer UM, Ehrler M, Lehmann T, et al. Pain-related functional interference in patients with chronic neuropathic postsurgical pain: an analysis of registry data. Pain, 2019, 160(8): 1856-1865.
8. Chen-Xu J, Bessa-Melo R, Gra?a L, et al. Incisional hernia in hepatobiliary and pancreatic surgery: incidence and risk factors. Hernia, 2019, 23(1): 67-79.
9. Cheema F, Andacoglu O, Huang LC, et al. Risk factors for surgical site occurrence or infection and recurrence after incisional hernia repair in abdominal transplant population. Transplant Proc, 2021, 53(2): 762-767.
10. 陳雙, 周太成. 多維度解析腹壁疝復發機制及治療策略. 中國實用外科雜志, 2025, 45(5): 501-503.
11. Bittner R, Bain K, Bansal VK, et al. Update of Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias (International Endohernia Society (IEHS))-Part A. Surg Endosc, 2019, 33(10): 3069-3139.
12. 李航宇. 從生物力學角度重新解讀腹壁重建. 中國實用外科雜志, 2021, 41(4): 379-383.
13. Scheuerlein H, Rauchfuss F, Gharbi A, et al. Laparoscopic incisional hernia repair after solid-organ transplantation. Transplant Proc, 2011, 43(5): 1783-1789.
14. Kuo SC, Lin CC, Elsarawy A, et al. Laparoscopic Repair of Incisional Hernia Following Liver Transplantation-Early Experience of a Single Institution in Taiwan. Transplant Proc, 2017, 49(8): 1870-1874.
15. Gianchandani R, Moneva E, Marrero P, et al. Feasibility and effectiveness of laparoscopic incisional hernia repair after liver transplantation. Transplant Proc, 2011, 43(3): 742-744.
16. 劉亦婷, 申英末. 腹腔鏡修補手術在肝移植術后切口疝的應用及其效果評估. 中華疝和腹壁外科雜志(電子版), 2025, 19(2): 202-205.
17. 符常波, 汪群, 段傳宜, 等. 腹腔鏡聯合開腹補片修補術對巨大切口疝及腸黏連緊密腹壁切口疝患者臨床研究. 中華疝和腹壁外科雜志 (電子版), 2020, 14(1): 55-58.
18. 陳亞柯, 陳建民, 王殿琢, 等. 3種不同層次間放置補片治療腹壁疝的臨床療效. 中國普外基礎與臨床雜志, 2021, 28(1): 38-42.
19. Bellido-Luque J, Alpizar O, Gomez Rosado JC, et al. Minimally invasive endoscopic retromuscular technique with transversus abdominis release associated (eTEP-TAR) for right subcostal incisional hernias improves postoperative results when compared to conventional laparoscopic incisional hernia repair: a case-control study. Hernia, 2024, 29(1): 34. doi: 10.1007/s10029-024-03186-7.
20. 江志鵬, 周太成, 曾兵, 等. 一種切口疝縫合的創新技術——“立體”縫合. 中國實用外科雜志, 2021, 41(2): 160-163.
21. 馬寧, 湯福鑫, 黃恩民, 等. “對位對線”補片固定法在腹腔鏡切口疝修補術中的應用. 中國普通外科雜志, 2022, 31(4): 474-480.
22. 夏建福, 袁航, 陳浩, 等. 三維打印技術在腹部外科的應用與局限性. 腹腔鏡外科雜志, 2021, 26(5): 388-391.
23. 楊榮鐸, 李紹春, 孟云瀟, 等. 應用CT三維重建技術評估肥胖對切口疝修補術后腹壁功能恢復及疝復發影響研究. 中國實用外科雜志, 2025, 45(4): 457-460.
24. 彭雪峰, 楊華, 李慧, 等. 三維可視化技術在復雜腹壁切口疝中的應用: 48例患者的臨床經驗總結. 中國普外基礎與臨床雜志, 2024, 31(8): 928-932.

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