Trocar Site Hernia Following Laparoscopy: A Case Report and Literature Review_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

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王亚军 , 刘强 , 赵磊光 , 刘家峰

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Keywords：

腹腔镜手术; 切口疝; 并发症

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目的探讨腹腔镜术后Trocar部位疝的发生、分型和诊治方法。方法 1例77岁的女性患者，因“右附件囊性畸胎瘤”行腹腔镜右附件切除术，术后2 d出现右下腹Trocar部位疝并发肠梗阻，结合文献对其发生率、分型、发病因素、临床表现、诊治原则及预防进行分析。结果手术证实部分小肠嵌顿于Trocar切口内，行小肠松解和切口缝合术，术后3 d痊愈出院。结论 Trocar部位疝并不少见，因素复杂，根据发生的时间和形态可将其分为早发型、迟发型和特殊型3型；多需要手术治疗，缝合Trocar切口筋膜是有效的预防方法。

Citation： 王亚军,刘强,赵磊光,刘家峰. Trocar Site Hernia Following Laparoscopy: A Case Report and Literature Review. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2009, 16(12): 1025-1028. doi: Copy

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.	郑国庆,　梁金荣,　何晓军. 腹腔镜胆囊切除术后并发Richter疝1例 [Ｊ]. 中国实用外科杂志, 2005； 25(10): 582.
9.	郑杰, 黄胡信, 夏恩兰，等. 腹腔镜术后5 mm切口网膜疝1例报告 [Ｊ]. 中国内镜杂志, 2007； 13(3): 335-336.
10.	许东训, 徐守森, 李俊峰. 腹腔镜术后腹膜切口疝1例 [Ｊ]. 腹腔镜外科杂志, 2001； 6(3): 147.
11.	吴文英, 王翠芹. 腹腔镜术后切口肠疝1例报告 [Ｊ]. 现代妇产科进展, 2008； 17(2): 116.
12.	于晨, 张奉春, 裴玉芳. 腹腔镜术后切口空肠疝1例分析 [Ｊ]. 中国误诊学杂志, 2009； 9(9): 2254-2255.
13.	黄盛松, 吴登龙, 谷宝军, 等. 多囊肾腹腔镜去顶减压术后脐切口疝1 例 [Ｊ]. 临床泌尿外科杂志, 2008； 23(10): 751.
14.	周可义, 晁志涛, 彭彦辉. 腹腔镜胆总管探查术后T管引流口戳孔疝1例 [Ｊ]. 河北医科大学学报, 2008； 29(3): 332.
15.	薛琪, 张福民, 黄祥成. 腹腔镜术后腹壁切口疝一例 [Ｊ]. 中华普通外科杂志, 2002； 17(8): 460.
16.	樊友本, 郭伯敏. 腹腔镜术术后戳孔疝一例报道 [Ｊ]. 外科理论与实践, 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, 杨培, 王东, 等. 1 3840例腹腔镜手术临床分析 [Ｊ]. 中国普外基础与临床杂志, 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. 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. 郑国庆,　梁金荣,　何晓军. 腹腔镜胆囊切除术后并发Richter疝1例 [Ｊ]. 中国实用外科杂志, 2005； 25(10): 582.
9. 郑杰, 黄胡信, 夏恩兰，等. 腹腔镜术后5 mm切口网膜疝1例报告 [Ｊ]. 中国内镜杂志, 2007； 13(3): 335-336.
10. 许东训, 徐守森, 李俊峰. 腹腔镜术后腹膜切口疝1例 [Ｊ]. 腹腔镜外科杂志, 2001； 6(3): 147.
11. 吴文英, 王翠芹. 腹腔镜术后切口肠疝1例报告 [Ｊ]. 现代妇产科进展, 2008； 17(2): 116.
12. 于晨, 张奉春, 裴玉芳. 腹腔镜术后切口空肠疝1例分析 [Ｊ]. 中国误诊学杂志, 2009； 9(9): 2254-2255.
13. 黄盛松, 吴登龙, 谷宝军, 等. 多囊肾腹腔镜去顶减压术后脐切口疝1 例 [Ｊ]. 临床泌尿外科杂志, 2008； 23(10): 751.
14. 周可义, 晁志涛, 彭彦辉. 腹腔镜胆总管探查术后T管引流口戳孔疝1例 [Ｊ]. 河北医科大学学报, 2008； 29(3): 332.
15. 薛琪, 张福民, 黄祥成. 腹腔镜术后腹壁切口疝一例 [Ｊ]. 中华普通外科杂志, 2002； 17(8): 460.
16. 樊友本, 郭伯敏. 腹腔镜术术后戳孔疝一例报道 [Ｊ]. 外科理论与实践, 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, 杨培, 王东, 等. 1 3840例腹腔镜手术临床分析 [Ｊ]. 中国普外基础与临床杂志, 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.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Trocar Site Hernia Following Laparoscopy: A Case Report and Literature Review

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