摘要目的:通过病例报告并结合文献复习,分析腹腔镜术后Trocar 部位疝(TSH)的发生原因、分型、临床表现、诊断、治疗及预防措施,提高对腹腔镜术后TSH 的诊疗水平。方法:报告1例泌尿外科腹腔镜术后发生TSH患者的诊治经过及随访结果,并结合文献复习对TSH的发生原因、分型、临床表现、诊断、治疗及预防措施进行分析。结果:51岁女性患者因“左侧脓肾切除术后,切口疼痛伴流脓,左肾区肿物”行腹腔镜下左侧肾区肿物切除术、窦道切除术,术后第4天出现左下腹12 mm Trocar部位疝并发肠梗阻,急诊剖腹探查,行肠管松解术和切口缝合术,术后7天患者痊愈出院,术后随访至今,无复发。结论:TSH是一种少见的腹腔镜手术并发症,发生率为0.18%~2.80%,多见于普外科和妇产科等经腹腔入路腹腔镜手术,我国泌尿外科腹腔镜手术多采用后腹腔入路,故极少发生,TSH临床上主要分为早发型、迟发型和特殊型三种,其发生涉及多种因素,一旦发生,无自愈可能,多需手术治疗。预防TSH的方法包括逐层严格关闭切口、改进Trocar外形、控制腹压等。
Abstract：Objective:To explore the etiology, classification, clinical manifestation, diagnosis, treatment and prevention of Trocar Site Hernia (TSH) after laparoscopic surgery through a case report and literature review.Methods:One case of TSH treated in our hospital department of urology was reported, and the relevant literature was reviewed to analyze the etiology, classification, clinical manifestation, diagnosis, treatment and prevention of TSH after laparoscopic surgery. Results:A 51 years old woman was admitted in our hospital because of post left pyonephrosis nephrectomy and a mass in the left kidney area. The mass was resected by laparoscopy. However,there was a TSH with intestinal obstruction at the 12-mm Trocar site on the fourth day after surgery, then small intestine lysis was did and the incision was closed during emergency exploratory laparotomy.The patient was discharged on the seventh day after surgery. Up to now, the follow-up was did and the TSH had no recurrence. Conclusions:TSH is a rare complication of laparoscopic surgery. The incidence of TSH has been shown to be about 0.18% to 2.80%, and TSH was mostly happened after transperitoneal laparoscopic surgery, but most surgeries in department of urology were performed by retroperitoneal approach so that TSH was rarely happened.We can classify TSH into early-onset type, late-onset type and special type. The occurrence of TSH is a result of a variety of factors, and most TSH needs surgical repair. Some measures could be taken to prevent the occurrence of TSH, such as a full-thickness suture, control abdominal pressure.
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