术前渐进性气腹技巧辅助治疗肝脏疝一例

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术前渐进性气腹技巧辅助治疗肝脏疝一例

汤福鑫¹, 周太成¹, 马宁¹, 甘文昌¹, 侯泽辉¹, 陈双¹^,^†(

)

Fuxin Tang¹, Taicheng Zhou¹, Ning Ma¹

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图1 气腹及手术前后腹壁肿物对比情况　a为入院时前腹壁可触及一个不可还纳的肿物，大小约为6.5 cm×8.0 cm×4.0 cm；b为位于患者左侧腋前线的人工气腹导管，同时患者在经历18 d气腹后可见疝囊容积较前有一定程度缩小、部分疝内容物自行还纳至腹腔中；c为术后第7天照片

图2 气腹前后CT图像对比，疝内容物自发性减少　a为腹壁缺损大小约12 cm×6 cm，气腹前疝囊容积、腹腔容积分别是335 ml、5 583 ml；b为气腹后腹腔中大量游离气体，疝囊容积、腹腔容积分别是138 ml、7 475 ml

图3 腹部CT横断面显示气腹前后胆囊的变化情况　a为气腹前CT显示胆囊部分疝出腹膜外；b为气腹后CT显示胆囊自行完全回纳至腹腔中

图4 术中肝脏回纳过程　a示肝脏疝出，肝与腹壁间有严重粘连；b为分离肝脏与腹壁间粘连；c示肝脏完全回纳至腹腔；d为在疝内容物完全回纳至腹腔后，清晰可见前腹壁缺损，术中测量大小约13 cm×5 cm；e为采用1个Prolene线连续缝合关闭缺损；f为补片平整的固定于腹壁上

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