摘要
耻骨上切口疝（SIH）是腹壁疝的一种少见特殊类型，特指发生在中线距耻骨弓4 cm以内切口疝，疝环邻近骨骼、血管、神经和膀胱等结构；由于该部位腹直肌后鞘缺失，手术治疗极具挑战性，手术方式的选择一直存在争议。传统开放手术仍有广泛的应用基础，腹腔镜手术迅速发展，各种新颖的术式涌出，开放与腹腔镜联合不失是种灵活的选择。在腹壁重建的过程中，外科医师不仅需要充分了解腹壁复杂的解剖结构和空间解剖关系，还得具备在狭窄空间中缝合的能力。选择手术方式时应注重个体化方案，充分评估患者的一般情况，依据术者自身经验、技术的可行性、材料的经济性、可及性和患者的总体经济负担综合考虑。本文旨在探讨如何选择合适的耻骨上切口疝手术方式，主要涉及手术指征、手术方法、并发症预防和处理等方面。
Abstract
Suprapubic incisional hernia (SIH) is a special type of abdominal wall incision hernia, which specifically refers to incision hernia that occurs within 4 cm from the midline to the pubic arch. The hernia ring is adjacent to the bone, blood vessels, nerves and bladder and other structures. Because the posterior sheath of the rectus abdominis muscle is missing, surgical treatment is very challenging, and the selection of appropriate surgical methods has been controversial. The purpose of this article is to discuss the selection of surgical options for SIH, including indications for surgery, surgical methods, and prevention and treatment of complications. Traditional open surgery is still widely used, and laparoscopic surgery has been rapidly developing, with a variety of novel surgical procedures emerging. The differences between the various surgical procedures lie in the different surgical accesses and the different levels of placement of the repair material; the combination of open and laparoscopic procedures is a flexible option. In the process of abdominal wall reconstruction, the surgeons not only need to fully understand the complex anatomical structure and spatial anatomical relationship of the abdominal wall, but also have the ability to suture in the narrow space. The choice of surgical procedures should be based on an individualized plan, thorough evaluation of the patients’ general condition, combination of experiences, technical feasibility, economic accessibility of materials, and the overall financial burden.
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