完全腹膜外腹腔镜疝修补术手术经验及技巧(附145例次报告)  

Techniques and skills of laparoscopic totally extraperitoneal hernia repair (a report of 145 cases)

作　　者：蔡小勇[1] 卢榜裕[1] 陆文奇[1] 黄飞[1] 黄玉斌[1] 江文枢[1] 刘祖军[1] 宴益核[1] 秦诚[1] 

机构地区：[1]广西医科大学微创外科中心,广西南宁530021

出　　处：《中国内镜杂志》2006年第10期1038-1040,1043,共4页China Journal of Endoscopy

摘　　要：目的总结该院腹腔镜完全腹膜外疝修补(totallyextraperitonealherniarepair,TEP)成功手术经验技巧,为该手术的推广普及提供借鉴。方法回顾分析该中心2002年10月～2005年5月120例病人,145次TEP手术病例,年龄18～91岁,平均52岁,包括直疝26例次,斜疝119例次,其中单侧疝95例,双侧疝25例,复发疝29例。结合作者手术经验,详细阐述分析TEP手术方法、步骤、难点技巧。结果120例病人共进行145次TEP手术,中转TAPP手术2例。手术时间30～180min,平均手术时间单侧68min,双侧105min。术后无需使用镇痛剂,住院时间5～12d,平均7d。主要并发症为阴囊血清肿或血肿16例(13.3%),术后腹股沟区疼痛2例,膀胱损伤1例。随访4～35个月,术后复发1例,为开展手术早期病例。结论TEP手术安全可靠,术后疼痛轻,恢复快,复发率低。手术时,主要能掌握TEP的一些手术要领和技巧,可以缩短学习曲线,手术并不困难。由于TEP手术在腹腔镜疝修补中优点明显,在我国应成为腹腔镜治疗腹股沟疝的主要术式。[Objective ] To evaluate the local experience and skills of laparoscopic totally extraperitoneal hernia repair （TEP） in a major teaching hospital in order to spread and popularize this kind of operation. [Methods] Between 2002 and 2005, 120 consecutive patients underwent 145 totally extraperitoneal hernia repairs for inguinal hernia.95 patients had unilateral hernia and 25 patients had bilateral hernias. The mean age was 52 years （range 18 to 91 years）. 26 cases diagnosed as direct inguinal hernia, 119 cases had indirect inguinal hernia and 29 cases are recurrent hernia. We discuss the operating method, procedure, difficulties and skills in detail according to our operating experiences. [Results] The 120 cases had been perfornled 145 TEP. 2 cases were converted from TEP to TAPP. The operating time was 30 to 180 minutes. The mean operating duration was 68 minutes for unilateral hernia and 105 minutes for bilateral one. The patients stay in hospital for 5 to 12 days. The mean inpatient hospital stay was 7 days. The patients do not need analgesics. Most complications are hematomas or seromas that account for 16 cases（13.3%）. 2 cases appeared inguinal pain and 1 case had bladder injury. All the patients were followed up for 4-30 months. There is only 1 patient recurrence and it occurred in the initial part of the series. [Conclusions] The procedure of TEP is safe, faster postoperative recover, less pain, and lower complications and recurrence rate. To achieve good results and overcome the learning curve, some techniques and skill of TEP should be commanded. TEP should be the best ooeratin- method for inguinal hernia because of its obvious advantage.

关 键 词：腹腔镜 腹股沟疝 疝修补术 

分 类 号：R656.21[医药卫生—外科学]