Purpose::Traumatic lumbar hernia (TLH) constitutes a protrusion of content through a defect in the posterior abdominal wall, as a result of injury. This rare entity has been described in limited number of cases.Methods::A systematic review of the literature was performed according to the meta-analysis of observational studies in epidemiology guidelines. The English literature from 1990 until 2021 was reviewed, using PubMed, EMBASE and Google Scholar bibliographic databases, to identify case reports and case series with patients that were diagnosed with TLH. For each eligible study, demographics, clinical presentation, hernia characteristics, preoperative imaging investigations, operation details, and postoperative data were extracted for assessment. Statistical analysis was performed on SPSS, version 20.0.Results::A total of 62 studies were included for review, with 164 patients with TLH. Mean age was (42.6 ± 14.3) years (47.6% males, 31.1% females, gender not specified in 35 cases). Mean diameter of hernia neck was (6.3 ± 3.1) cm, while the triangles of Petit and Grynfeltt were affected in 74.5% and 14.6%, respectively. Patients diagnosed in the emergency setting account for 54.2%, with CT scan establishing diagnosis in all but one case (97.7%). A delayed diagnosis was made in 45.8%, at a mean 1 year following trauma. Flank bulging (82.8%) and chronic back pain (34.3%) were the most frequent symptoms. In both delayed and acute group, open surgery (63.6% and 92.3%, respectively) was the preferred surgical approach. Postoperative complications were reported in 11.4% of acute and 15.0% of delayed patients. Hernia recurrence was 7%.Conclusions::TLH is uncommon with 164 cases described since 1990. CT scan is the gold standard in diagnosis. Open surgery is generally the preferred approach, particularly in the emergency setting. Acute TLH can be treated either by primary suture repair or mesh, depending on the local conditions, whereas delayed cases usually require a mesh.

腰疝是指发生在第12肋至髂嵴之间的腹后外侧壁的疝,总体发病率较少,仅占所有腹外疝的1.5％～2.0％.成人腰疝可分为原发性和继发性,继发性腰疝主要是手术和创伤所致,约占所有腰疝的25％;原发性腰疝原因不明,可能与腹内压升高和老龄肌肉萎缩有关,约占所有腰疝的55％[1].原发性腰疝根据部位不同也可分为上腰三角疝(Grynfeltt-Lesshaft疝)和下腰三角疝(Petit疝).既往腰疝治疗的金标准是行腹膜前开放手术[2],应用腹腔镜治疗则是进入腹腔后再实施腹膜外分离[1,3].国内尚无采用泌尿外科常用的后腹腔入路的微创手术治疗腰疝的报道.笔者结合泌尿外科的后腹腔镜手术,同时通过前期的尸体解剖操作练习,熟练掌握后腹腔区域的入路方法和解剖情况,近期成功为2例原发性的上腰疝病人实施后腹腔入路的内镜下全腹膜外补片修补术(retroperitoneal totally endoscopic prosthetic repair,R-TEP),取得良好效果.现报道如下.

腰疝是一种少见的发生在腰背侧的腹壁疝,位于第12 肋和髂嵴之间,患病率占所有腹外疝的1.5％～2.0％.腰疝分为先天性( 20％)、原发性(55％)和继发性(25％) [1].原发性腰疝更为常见,可以发生在腰上三角( Grynfeltt )或者腰下三角( Petit).目前,治疗腰疝的手术方式众多,尚无金标准术式,常用的是开放式或者腹腔镜使用人工材料进行腹膜前无张力修补术[2,3] ,腹腔镜手术需要进入腹腔分离腹膜前间隙.在国内,后腹腔入路腹腔镜下完全腹膜后腰疝修补的报道目前仍较少.2021年4～5月我科对2例原发性上腰疝行腹腔镜完全腹膜后修补术,取得良好效果,现报道如下.