腹腔镜腹股沟疝修补术的经验总结(附235例报告)  

Laparoscopic inguinal hernia repair (a report of 235 cases)

作　　者：李健文[1] 郑民华[1] 董峰[1] 王明亮[1] 陆爱国[1] 胡伟国[1] 毛志海[1] 臧潞[1] 蒋渝[1] 

机构地区：[1]上海第二医科大学附属瑞金医院外科上海市微创外科临床医学中心,上海200025

出　　处：《外科理论与实践》2005年第2期126-128,共3页Journal of Surgery Concepts & Practice

摘　　要：目的:评价腹腔镜腹股沟疝修补术的安全性和有效性,分析术后复发与并发症的原因;比较经腹腹膜前补片植入术(TAPP)与全腹膜外补片植入术(TEP)的手术疗效。方法:回顾性分析1997年1月至2005年1月行腹腔镜腹股沟疝修补术的235例(274例次)病人的临床资料,其中TAPP139例(163例次),TEP96例(111例次),随访时间1～24个月(中位时间15个月)。结果:手术无中转,术后复发率为1.46%(4/274),前3位并发症依此为血清肿5.11%(14/274),暂时性神经感觉异常4.74%(13/274)和尿潴留2.92%(8/274);平均手术时间为(57.1±18.6)min(25～140min),术后平均住院天数为(5.84±1.44)d,2周和4周内恢复非限制性活动人数分别为96.2%(226/235)和100%,术后无需应用镇痛剂;TAPP与TEP在手术时间、复发率、并发症率、术后住院天数、恢复非限制性活动时间上差异无显著性(P>0.05);Ⅲ型疝的血清肿发生率高于其他各型(P=0.041)。结论:TAPP和TEP都是安全有效的无张力修补方法,手术效果及术式选择取决于术者的临床经验。Objective To evaluate the safety and effectiveness of laparoscopic inguinal hernia repair; to analyze the recurrence and complications of this technique; and to compare the effectiveness of transabdominal preperitoneal(TAPP) and totally extraperitoneal (TEP). Methods The clinical data of 274 operations in 235 patients undergoing laparoscopic inguinal hernia repair between Jan. 1997 and Jan. 2005 were retrospectively analyzed, there were 163 operations of TAPP performed in 139 patients and 111 operations of TEP in 96 patients. The cases were followed-up for 1-24 months with a median of 15 months. Results No conversion to open surgery occurred. The recurrence rate was 1.46%(4/274). Hematoma /seroma, transient neurapraxia and urinary retention were the most common postoperative complications with an incidence of 5.11%(14/274), 4.74%(13/274) and 2.92%(8/274) respectively. The operating time was (57.1±18.6) min (25-140min). The postoperative hospital stay was (5.84±1.44) days.Of the 235 patients,96.2% returned to mormal activity in 2 weeks,and 100% in 4 weeks. No patient asked for any antalgesics. There was no significant difference between TAPP and TEP in terms of recurrence, postoperative complications, length of hospital stay and time to return to normal activity. The incidence of seroma in type Ⅲ hernias was significantly higher than the other types (P=0.041). Conclusions TAPP and TEP are both safe and effective tension-free techniques. The choice of the approach depends mainly on the surgeons' experience and preference.

关 键 词：疝修补术 腹腔镜 疝 腹股沟 方法 

分 类 号：R656.21[医药卫生—外科学]