• 首都醫(yī)科大學(xué)宣武醫(yī)院普外科（北京 100053）;

目的  探討腹腔鏡術(shù)后Trocar部位疝的發(fā)生、分型和診治方法。方法  1例77歲的女性患者，因“右附件囊性畸胎瘤”行腹腔鏡右附件切除術(shù)，術(shù)后2 d出現(xiàn)右下腹Trocar部位疝并發(fā)腸梗阻，結(jié)合文獻(xiàn)對(duì)其發(fā)生率、分型、發(fā)病因素、臨床表現(xiàn)、診治原則及預(yù)防進(jìn)行分析。結(jié)果  手術(shù)證實(shí)部分小腸嵌頓于Trocar切口內(nèi)，行小腸松解和切口縫合術(shù)，術(shù)后3 d痊愈出院。結(jié)論  Trocar部位疝并不少見，因素復(fù)雜，根據(jù)發(fā)生的時(shí)間和形態(tài)可將其分為早發(fā)型、遲發(fā)型和特殊型3型； 多需要手術(shù)治療，縫合Trocar切口筋膜是有效的預(yù)防方法。

引用本文： 王亞軍,劉強(qiáng),趙磊光,劉家峰. 腹腔鏡術(shù)后Trocar部位疝1例報(bào)道并文獻(xiàn)復(fù)習(xí). 中國(guó)普外基礎(chǔ)與臨床雜志, 2009, 16(12): 1025-1028. doi: 復(fù)制

1. Fear RE. Laparoscopy: a valuable aid in gynecologic diagnosis [Ｊ]. Obstet Gynecol， 1968； 31(3): 297-309.
2. Maio A, Ruchman RB. CT diagnosis of postlaparoscopic hernia [Ｊ]. J Comput Assist Tomogr, 1991； 15(6): 1054-1055.
3. Montz FJ, Holschneider CH, Munro MG. Incisional hernia following laparoscopy: a survey of the American Association of Gynecologic Laparoscopists [Ｊ]. Obstet Gynecol, 1994； 84(5): 881-884.
4. Bergemann JL, Hibbert ML, Harkins G, et al. Omental herniation through a 3-mm umbilical trocar site: unmasking a hidden umbilical hernia [Ｊ]. J Laparoendosc Adv Surg Tech A, 2001； 11(3): 171-173.
5. Duca S, Bl O, Al-Hajjar N, et al. Laparoscopic cholecystectomy: incidents and complications. A retrospective analysis of 9 542 consecutive laparoscopic operations [Ｊ]. HPB (Oxford), 2003； 5(3): 152-158.
6. Sanz-López R, Martínez-Ramos C, Núez-Pea JR， et al. Incisional hernias after laparoscopic vs open cholecystectomy [Ｊ]. Surg Endosc, 1999； 13(9): 922-924.
7. Liu CD, McFadden DW. Laparoscopic port sites do not require fascial closure when nonbladed trocars are used [Ｊ]. Am Surg, 2000； 66(9): 853-854.
8. 鄭國(guó)慶,　 梁金榮,　 何曉軍. 腹腔鏡膽囊切除術(shù)后并發(fā)Richter疝1例 [Ｊ]. 中國(guó)實(shí)用外科雜志, 2005； 25(10): 582.
9. 鄭杰, 黃胡信, 夏恩蘭， 等. 腹腔鏡術(shù)后5 mm切口網(wǎng)膜疝1例報(bào)告 [Ｊ]. 中國(guó)內(nèi)鏡雜志, 2007； 13(3): 335-336.
10. 許東訓(xùn), 徐守森, 李俊峰. 腹腔鏡術(shù)后腹膜切口疝1例 [Ｊ]. 腹腔鏡外科雜志, 2001； 6(3): 147.
11. 吳文英, 王翠芹. 腹腔鏡術(shù)后切口腸疝1例報(bào)告 [Ｊ]. 現(xiàn)代婦產(chǎn)科進(jìn)展, 2008； 17(2): 116.
12. 于晨, 張奉春, 裴玉芳. 腹腔鏡術(shù)后切口空腸疝1例分析 [Ｊ]. 中國(guó)誤診學(xué)雜志, 2009； 9(9): 2254-2255.
13. 黃盛松, 吳登龍, 谷寶軍, 等. 多囊腎腹腔鏡去頂減壓術(shù)后臍切口疝1 例 [Ｊ]. 臨床泌尿外科雜志, 2008； 23(10): 751.
14. 周可義, 晁志濤, 彭彥輝. 腹腔鏡膽總管探查術(shù)后T管引流口戳孔疝1例 [Ｊ]. 河北醫(yī)科大學(xué)學(xué)報(bào), 2008； 29(3): 332.
15. 薛琪, 張福民, 黃祥成. 腹腔鏡術(shù)后腹壁切口疝一例 [Ｊ]. 中華普通外科雜志, 2002； 17(8): 460.
16. 樊友本, 郭伯敏. 腹腔鏡術(shù)術(shù)后戳孔疝一例報(bào)道 [Ｊ]. 外科理論與實(shí)踐, 2008； 13(6): 603-604.
17. Tonouchi H, Ohmori Y, Kobayashi M, et al. Trocar site hernia [Ｊ]. Arch Surg， 2004； 139(11): 1248-1256.
18. Yee DS, Duel BP. Omental herniation through a 3-mm umbilical trocar site [Ｊ]. J Endourol, 2006, 20(2): 133-134.
19. Paya K, Wurm J, Fakhari M, et al. Trocar-site hernia as a typical postoperative complication of minimally invasive surgery among preschool children [Ｊ]. Surg Endosc, 2008； 22(12): 2724-2727.
20. Backman T, Arnbjrnsson E, Kullendorff CM. Omentum herniation at a 2-mm trocar site [Ｊ]. J Laparoendosc Adv Surg Tech A, 2005； 15(1): 87-88.
21. Azurin DJ, Go LS, Arroyo LR, et al. Trocar site herniation following laparoscopic cholecystectomy and the significance of an incidental preexisting umbilical hernia [Ｊ]. Am Surg, 1995； 61(8): 718-720.
22. Holzinger F, Klaiber C. Trocar site hernias. A rare but potentially dangerous complication of laparoscopic surgery [Ｊ]. Chirurg, 2002； 73(9): 899-904.
23. Nassar AH, Ashkar KA, Rashed AA, et al. Laparoscopic cholecystectomy and the umbilicus [Ｊ]. Br J Surg, 1997； 84(5): 630-633.
24. Plaus WJ. Laparoscopic trocar site hernias [Ｊ]. J Laparoendosc Surg, 1993； 3(6): 567- 570.
25. Duron JJ, Hay JM, Msika S, et al. Prevalence and mechanisms of small intestinal obstruction following laparoscopic abdominal surgery: a retrospective multicenter study. French Association for Surgical Research [Ｊ]. Arch Surg, 2000； 135(2): 208-212.
26. Immè A, Cardì F. Incisional hernia at the trocar site in laparoscopic surgery [Ｊ]. Chir Ital, 2006； 58(5): 605-609.
27. Korenkov M, Rixen D, Paul A, et al. Combined abdominal wall paresis and incisional hernia after laparoscopic cholecystectomy [Ｊ]. Surg Endosc, 1999； 13(3): 268-269.
28. Tarnay CM, Glass KB, Munro MG. Incision characteristics associated with six laparoscopic trocar-cannula systems: a randomized, observer blinded comparison [Ｊ]. Obstet Gynecol, 1999； 94(1): 89-93.
29. Leibl BJ, Schmedt CG, Schwarz J, et al. Laparoscopic surgery complications associated with trocar tip design: review of literature and own results [Ｊ]. J Laparoendosc Adv Surg Tech A, 1999； 9(2): 135-140.
30. Bowrey DJ, Blom D, Crookes PF, et al. Risk factors and the prevalence of trocar site herniation after laparoscopic fundoplication [Ｊ]. Surg Endosc, 2001； 15(7): 663-666.
31. Neri V, Fersini A, Ambrosi A, et al. Umbilical port-site co-mplications in laparoscopic cholecystectomy: role of topical antibiotic therapy [Ｊ]. JSLS, 2008； 12(2): 126-132.
32. Boughey JC, Nottingham JM, Walls AC. Richter’s hernia in the laparoscopic era: four case reports and review of the literature [Ｊ]. Surg Laparosc Endosc Percutan Tech, 2003； 13(1): 55-58.
33. Wicks A, Voyvodic F, Scroop R. Incisional hernia and small bowel obstruction following laparoscopic surgery: computed tomography diagnosis [Ｊ]. Australas Radiol, 2000； 44(3): 331-332.
34. Cadeddu MO, Schlachta CM, Mamazza J, et al. Soft-tissue images. Trocar-site hernia after laparoscopic procedures [Ｊ]. Can J Surg, 2002； 45(1): 9-10.
35. Velasco JM, Vallina VL, Bonomo SR. Postlaparoscopic sm-all bowel obstruction. Rethinking its management [Ｊ]. Surg Endosc, 1998； 12(8): 1043-1045.
36. 黎前德, 楊培, 王東, 等. 1 3840例腹腔鏡手術(shù)臨床分析 [Ｊ]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2005； 12(6): 554-557.
37. Crist DW, Gadacz TR. Complications of laparoscopic surgery [Ｊ]. Surg Clin North Am, 1993； 73(2): 265-289.
38. Moreno-Sanz C, Picazo-Yeste JS, Manzanera-Díaz M, et al. Prevention of trocar site hernias: description of the safe port plug technique and preliminary results [Ｊ]. Surg Innov, 2008； 15(2): 100-104.
  1. 1. Fear RE. Laparoscopy: a valuable aid in gynecologic diagnosis [Ｊ]. Obstet Gynecol， 1968； 31(3): 297-309.
  2. 2. Maio A, Ruchman RB. CT diagnosis of postlaparoscopic hernia [Ｊ]. J Comput Assist Tomogr, 1991； 15(6): 1054-1055.
  3. 3. Montz FJ, Holschneider CH, Munro MG. Incisional hernia following laparoscopy: a survey of the American Association of Gynecologic Laparoscopists [Ｊ]. Obstet Gynecol, 1994； 84(5): 881-884.
  4. 4. Bergemann JL, Hibbert ML, Harkins G, et al. Omental herniation through a 3-mm umbilical trocar site: unmasking a hidden umbilical hernia [Ｊ]. J Laparoendosc Adv Surg Tech A, 2001； 11(3): 171-173.
  5. 5. Duca S, Bl O, Al-Hajjar N, et al. Laparoscopic cholecystectomy: incidents and complications. A retrospective analysis of 9 542 consecutive laparoscopic operations [Ｊ]. HPB (Oxford), 2003； 5(3): 152-158.
  6. 6. Sanz-López R, Martínez-Ramos C, Núez-Pea JR， et al. Incisional hernias after laparoscopic vs open cholecystectomy [Ｊ]. Surg Endosc, 1999； 13(9): 922-924.
  7. 7. Liu CD, McFadden DW. Laparoscopic port sites do not require fascial closure when nonbladed trocars are used [Ｊ]. Am Surg, 2000； 66(9): 853-854.
  8. 8. 鄭國(guó)慶,　 梁金榮,　 何曉軍. 腹腔鏡膽囊切除術(shù)后并發(fā)Richter疝1例 [Ｊ]. 中國(guó)實(shí)用外科雜志, 2005； 25(10): 582.
  9. 9. 鄭杰, 黃胡信, 夏恩蘭， 等. 腹腔鏡術(shù)后5 mm切口網(wǎng)膜疝1例報(bào)告 [Ｊ]. 中國(guó)內(nèi)鏡雜志, 2007； 13(3): 335-336.
  10. 10. 許東訓(xùn), 徐守森, 李俊峰. 腹腔鏡術(shù)后腹膜切口疝1例 [Ｊ]. 腹腔鏡外科雜志, 2001； 6(3): 147.
  11. 11. 吳文英, 王翠芹. 腹腔鏡術(shù)后切口腸疝1例報(bào)告 [Ｊ]. 現(xiàn)代婦產(chǎn)科進(jìn)展, 2008； 17(2): 116.
  12. 12. 于晨, 張奉春, 裴玉芳. 腹腔鏡術(shù)后切口空腸疝1例分析 [Ｊ]. 中國(guó)誤診學(xué)雜志, 2009； 9(9): 2254-2255.
  13. 13. 黃盛松, 吳登龍, 谷寶軍, 等. 多囊腎腹腔鏡去頂減壓術(shù)后臍切口疝1 例 [Ｊ]. 臨床泌尿外科雜志, 2008； 23(10): 751.
  14. 14. 周可義, 晁志濤, 彭彥輝. 腹腔鏡膽總管探查術(shù)后T管引流口戳孔疝1例 [Ｊ]. 河北醫(yī)科大學(xué)學(xué)報(bào), 2008； 29(3): 332.
  15. 15. 薛琪, 張福民, 黃祥成. 腹腔鏡術(shù)后腹壁切口疝一例 [Ｊ]. 中華普通外科雜志, 2002； 17(8): 460.
  16. 16. 樊友本, 郭伯敏. 腹腔鏡術(shù)術(shù)后戳孔疝一例報(bào)道 [Ｊ]. 外科理論與實(shí)踐, 2008； 13(6): 603-604.
  17. 17. Tonouchi H, Ohmori Y, Kobayashi M, et al. Trocar site hernia [Ｊ]. Arch Surg， 2004； 139(11): 1248-1256.
  18. 18. Yee DS, Duel BP. Omental herniation through a 3-mm umbilical trocar site [Ｊ]. J Endourol, 2006, 20(2): 133-134.
  19. 19. Paya K, Wurm J, Fakhari M, et al. Trocar-site hernia as a typical postoperative complication of minimally invasive surgery among preschool children [Ｊ]. Surg Endosc, 2008； 22(12): 2724-2727.
  20. 20. Backman T, Arnbjrnsson E, Kullendorff CM. Omentum herniation at a 2-mm trocar site [Ｊ]. J Laparoendosc Adv Surg Tech A, 2005； 15(1): 87-88.
  21. 21. Azurin DJ, Go LS, Arroyo LR, et al. Trocar site herniation following laparoscopic cholecystectomy and the significance of an incidental preexisting umbilical hernia [Ｊ]. Am Surg, 1995； 61(8): 718-720.
  22. 22. Holzinger F, Klaiber C. Trocar site hernias. A rare but potentially dangerous complication of laparoscopic surgery [Ｊ]. Chirurg, 2002； 73(9): 899-904.
  23. 23. Nassar AH, Ashkar KA, Rashed AA, et al. Laparoscopic cholecystectomy and the umbilicus [Ｊ]. Br J Surg, 1997； 84(5): 630-633.
  24. 24. Plaus WJ. Laparoscopic trocar site hernias [Ｊ]. J Laparoendosc Surg, 1993； 3(6): 567- 570.
  25. 25. Duron JJ, Hay JM, Msika S, et al. Prevalence and mechanisms of small intestinal obstruction following laparoscopic abdominal surgery: a retrospective multicenter study. French Association for Surgical Research [Ｊ]. Arch Surg, 2000； 135(2): 208-212.
  26. 26. Immè A, Cardì F. Incisional hernia at the trocar site in laparoscopic surgery [Ｊ]. Chir Ital, 2006； 58(5): 605-609.
  27. 27. Korenkov M, Rixen D, Paul A, et al. Combined abdominal wall paresis and incisional hernia after laparoscopic cholecystectomy [Ｊ]. Surg Endosc, 1999； 13(3): 268-269.
  28. 28. Tarnay CM, Glass KB, Munro MG. Incision characteristics associated with six laparoscopic trocar-cannula systems: a randomized, observer blinded comparison [Ｊ]. Obstet Gynecol, 1999； 94(1): 89-93.
  29. 29. Leibl BJ, Schmedt CG, Schwarz J, et al. Laparoscopic surgery complications associated with trocar tip design: review of literature and own results [Ｊ]. J Laparoendosc Adv Surg Tech A, 1999； 9(2): 135-140.
  30. 30. Bowrey DJ, Blom D, Crookes PF, et al. Risk factors and the prevalence of trocar site herniation after laparoscopic fundoplication [Ｊ]. Surg Endosc, 2001； 15(7): 663-666.
  31. 31. Neri V, Fersini A, Ambrosi A, et al. Umbilical port-site co-mplications in laparoscopic cholecystectomy: role of topical antibiotic therapy [Ｊ]. JSLS, 2008； 12(2): 126-132.
  32. 32. Boughey JC, Nottingham JM, Walls AC. Richter’s hernia in the laparoscopic era: four case reports and review of the literature [Ｊ]. Surg Laparosc Endosc Percutan Tech, 2003； 13(1): 55-58.
  33. 33. Wicks A, Voyvodic F, Scroop R. Incisional hernia and small bowel obstruction following laparoscopic surgery: computed tomography diagnosis [Ｊ]. Australas Radiol, 2000； 44(3): 331-332.
  34. 34. Cadeddu MO, Schlachta CM, Mamazza J, et al. Soft-tissue images. Trocar-site hernia after laparoscopic procedures [Ｊ]. Can J Surg, 2002； 45(1): 9-10.
  35. 35. Velasco JM, Vallina VL, Bonomo SR. Postlaparoscopic sm-all bowel obstruction. Rethinking its management [Ｊ]. Surg Endosc, 1998； 12(8): 1043-1045.
  36. 36. 黎前德, 楊培, 王東, 等. 1 3840例腹腔鏡手術(shù)臨床分析 [Ｊ]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2005； 12(6): 554-557.
  37. 37. Crist DW, Gadacz TR. Complications of laparoscopic surgery [Ｊ]. Surg Clin North Am, 1993； 73(2): 265-289.
  38. 38. Moreno-Sanz C, Picazo-Yeste JS, Manzanera-Díaz M, et al. Prevention of trocar site hernias: description of the safe port plug technique and preliminary results [Ｊ]. Surg Innov, 2008； 15(2): 100-104.