上一頁

多次手術仍然復發的疝氣如何治療:個案專家討論

健康情報站


收術

病人在過去二十多年接受過八次左側疝修補手術,包括整型科的皮瓣移植重建,皆再復發,最後兩次是內視鏡疝修補手術,還是失敗, CT 顯示如附圖.

IPOM?TIPP?若用Ti-mesh會較服貼一半在腹膜前一半在腹膜onlay, 但不知好不好分,病人用過三次mesh, 也開過robot!

以上是開過8次左側疝氣手術仍然復發病人的CT 和外覌

光想到前面後面都開過就頭皮發麻!更不用說總共八次手術!!
非常好奇院長怎麼處理?

所以才請各位專家提供髙見,由前面開除疤痕組織及殘留人工網外又怕傷到移植 flap 的血液供應,後面 scope approach 又因已開過三次內鏡手術(包括一次prostate), 腹膜前空間不易展開而且危險.請教黃院長手術發現及如何修補如此困難的病例CT 看起來是較高的地方突出 屬於atypical lateral hernia 好像有兩側hernia?
這個實在太難了!


scope 的話 試著剝離沾黏 用IPOM , SUPRO-PUBIC的方式看看

萬一失敗 就從中線OPEN進去  stoppa repair (maybe IPOM)
真的棘手 
真想上去做紀錄片


蔡理事長及蔡主任的CT reading 太厲害了,右邊也有原發疝氣,左邊因多次復發,屬extrafurnicular (atypical, direct type, ) lateral triangle hernia
這對我們年輕醫生來講,真是太難太複雜了。希望往後有機會聽到顧問寶貴經驗的分享!


明天有新的eTEP,我們趕快把多次復發左側疝氣結案:由於開過八次手術包括最後兩次內视鏡修補及前列腺癌 robot 手術,內視腹膜前空間的分離一定相當困難而且危險,即使用Ipom也需把人工網下端插到恥骨縫合及Cooper勒帶前,游離膀胱及股孔,最後還是採前開式後人工網修補(TIPP)術後三個月沒有復發。

 

上一頁


留言


姓名:


email:


發表內容:



更多相關學識

108歲高齡者的疝氣手術

Posted on May 28th, 2020 by admin | 2148 views

復發性腹股溝疝氣的無張力人工網修補經驗報告

Posted on May 25th, 2020 by admin | 9208 views

小兒復發性疝氣

Posted on May 25th, 2020 by admin | 657 views

疝氣及腹壁外科手術教科書

Posted on May 23rd, 2020 by admin | 1761 views

2019 南京國際疝與腹壁外科高峰會

Posted on May 21st, 2020 by admin | 540 views

多次手術仍然復發的疝氣如何治療:個案專家討論

Posted on May 19th, 2020 by admin | 1114 views

四面荷花三面柳,一城山色半城湖 ~ 濟南山東省立醫院泰山大課堂演講:無張力疝氣手術經驗

Posted on May 17th, 2020 by admin | 529 views

疝氣修補與闌尾手術

Posted on May 28th, 2018 by admin | 6824 views

從傳統手術到無張力手術:鼠蹊部疝氣治療的新里程

Posted on May 26th, 2018 by admin | 7184 views

歐洲疝氣醫學會(EHS)疝氣治療指引

Posted on May 22nd, 2018 by admin | 1207 views

造口旁疝的腹腔鏡手術

Posted on May 19th, 2018 by admin | 792 views

第十五屆亞太疝氣醫學會: 峇里島 , Faculty speech

Posted on May 17th, 2018 by admin | 478 views

106年度【台灣醫療典範獎】得主

Posted on December 20th, 2017 by admin | 996 views

APHS腹股溝疝氣修補準則( Guidelines 2014)

Posted on January 13th, 2016 by admin | 2965 views

我的疝氣手術與教學

Posted on February 6th, 2015 by admin | 10711 views

出席第九屆亞太疝氣醫學會記行

Posted on July 30th, 2014 by admin | 2614 views

腹壁切口疝氣的治療

Posted on August 29th, 2012 by admin | 26269 views

以耻骨肌孔(MPO)之病理解剖為依據的無張力腹股 溝疝修補手術

Posted on May 14th, 2012 by admin | 4461 views

疝氣手術的新進展

Posted on April 10th, 2009 by admin | 22252 views

腹股溝疝氣手術方法比較的新實證醫學

Posted on December 16th, 2008 by admin | 13377 views

疝氣修補衛教資料

Posted on July 15th, 2008 by admin | 16165 views

疝氣手術方法的選擇,需不需要使用人工網?

Posted on November 21st, 2007 by admin | 35037 views

疝氣醫學會招募

Posted on July 13th, 2007 by admin | 4647 views

荷蘭的疝氣手術

Posted on May 7th, 2007 by admin | 7243 views

台灣疝氣醫學會成立大會 — 會議記錄

Posted on April 12th, 2007 by admin | 5252 views

疝氣醫學會發起

Posted on March 13th, 2007 by admin | 4219 views

疝氣醫學會籌備I

Posted on March 13th, 2007 by admin | 3714 views

疝氣醫學會籌備II

Posted on March 13th, 2007 by admin | 3841 views

台灣疝氣醫學會組織章程

Posted on March 13th, 2007 by admin | 3784 views

台灣疝氣醫學會logo

Posted on March 13th, 2007 by admin | 6774 views

台灣疝氣醫學會籌備期間徵求會員公告

Posted on March 13th, 2007 by admin | 6138 views

切口疝氣與腹疝氣的手術治療

Posted on March 13th, 2007 by admin | 15049 views

小兒的腹股溝疝氣

Posted on March 13th, 2007 by admin | 67138 views

傳統組織對組織修補到無張力手術鼠蹊部疝氣手術新進展(一般常識)

Posted on March 13th, 2007 by admin | 9909 views

復發性腹股溝疝氣的無張力人工網修補經驗報告

Posted on March 11th, 2007 by admin | 9690 views

亞太疝氣醫學會(APHS)

Posted on March 11th, 2007 by admin | 8435 views

認識疝氣

Posted on March 10th, 2007 by admin | 184720 views

何謂疝氣

Posted on March 9th, 2007 by admin | 50356 views