免气囊分离器全腹膜外腹腔镜腹股沟疝修补术(附44例报告)  

Total extraperitoneal repair of groin hernia without using a dissection ballon(a report of 44 cases)

作　　者：刘嘉林[1] 周汉新[1] 余小舫[1] 鲍世韵[1] 帅建[1] 王劲[1] 吴海雄[1] 毕建钢[1] 

机构地区：[1]暨南大学第二附属医院肝胆外科,广东深圳518020

出　　处：《外科理论与实践》2005年第2期129-132,共4页Journal of Surgery Concepts & Practice

摘　　要：目的:探讨免气囊分离器完全腹膜外腹腔镜腹股沟疝修补术(TEP)的可行性,分析免气囊分离器TEP中常见的操作难点与失误及其对策。方法:自2003年11月～2005年1月,完成44例病人共51例次腹股沟疝的免气囊分离器TEP,其中斜疝37例次,直疝14例次。按斜、直疝分为两组,观察记录病人一般资料、体重指数(BMI)、分型、手术时间、术中出血量、术后出血量、术后住院时间、恢复日常活动时间、手术操作失误及并发症。结果:斜疝与直疝比较,除了斜疝组腹膜撕裂8例次显著大于直疝组3例次外(χ2=10.37,P=0.001),两组年龄、BMI、手术时间、术中出血、术后出血、住院天数及恢复天数间的差异均无统计学意义。斜疝组发生腹壁下血管游离3例次,鞘膜积液4例次。两组广泛皮下气肿各有1例次。两组均未见术后神经性疼痛、腹股沟血肿和切口感染。全组随访时间1～14个月,无一例疝复发。结论:免气囊分离器TEP是安全、可行的,主要的操作失误和手术并发症有腹膜撕裂、腹壁下血管游离、皮下气肿以及鞘膜积液。Objective To discuss the feasibility of total extraperitoneal repair (TEP) of groin hernia without using a dissection balloon. Methods Fifty-one groin hernias in forty-four patients undergoing TEP without employing a dissection balloon from Nov. 2003 to Jan. 2005, were analyzed; they consisted of 37 indirect and 14 direct hernias. Data concerning the general information, body mass index (BMI), classification, operating time, operative blood loss, postoperative blooding loss, postoperative hospital stay, return to normal activity and operative complications were collected. Results TEP without using a dissection balloon was carried out in 44 patients in whom no recurrence occurred 1 to 14 months after operation. Comparing the 2 groups, peritoneal laceration occurred 8 times in the indirect hernia group, it was higher than that in the direct hernia group(χ2=10.37,P=0.001); but no difference was found as to mistaken dissection of the epigastric vessels, pneumoderma and postoperative hydrocele between the 2 groups. Conclusions TEP without using a dissection balloon is a feasible , reliable and effective hernia repair with an acceptable incidence of operative complications such as peritoneal laceration, mistaken dissection of the epigastric vessels, pneumoderma and postoperative hydrocele.

关 键 词：疝 腹股沟 免气囊分离器 疝修补术 腹腔镜 

分 类 号：R656.21[医药卫生—外科学]