腹腔镜腹股沟疝修补术300例  

Laparoscopic Inguinal Hernia Repair:Report of 300 Cases

作　　者：王卫军[1,2] 方钱[1,2] 李剑锋[1,2] 金鹏飞[1,2] 李智涛[1,2] 李嘉根[1,2] 

机构地区：[1]浙江省温岭市第一人民医院微创外科医学中心 [2]温州医学院附属温岭医院微创外科医学中心,温岭317500

出　　处：《中国微创外科杂志》2011年第5期391-393,共3页Chinese Journal of Minimally Invasive Surgery

基　　金：浙江省医药卫生科学资助基金(2010KYA188)

摘　　要：目的评价腹腔镜腹股沟疝修补术的安全性和有效性。方法 2005年3月～2010年3月行腹腔镜腹股沟疝修补术300例(357侧),其中TAPP 221例(273侧),TEP 79例(84侧)。TAPP:建立气腹后打开腹膜,回纳疝囊,分离出腹膜前间隙,置入补片后钉合器固定,关闭腹膜。TEP:在腹膜前钝性建立足够间隙,回纳疝囊,置入补片覆盖缺损后放气。结果 300例手术全部顺利完成手术,无中转开放手术。TAPP和TEP手术时间分别为30～150 min和25～110 min,平均44.2 min和36.7 min。术后未使用止痛剂。并发症:血清肿(包括血肿)占15.0%(45/300),暂时性神经感觉异常(包括疼痛)占7.7%(23/300),腹壁下动脉损伤占1.3%(4/300),尿潴留占0.6%(2/300),输精管损伤占0.3%(1/300)。术后住院3～10 d,平均4.8 d。术后2周和4周恢复非限制性活动人数分别占94.0%(282/300)和100%。267例随访2～60个月,平均24.2月,均无复发。结论 TAPP与TEP都是安全有效的无张力疝修补方法,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 efficacy of laparoscopic inguinal hernia repair.Methods The clinical data of 300 cases（357 sides） who received laparoscopic inguinal hernia repair,including 221 cases（273 sides） of transabdominal preperitoneal（TAPP） and 79 cases（84 sides） of totally extraperitoneal（TEP）,from March 2005 to March 2010 were analyzed retrospectively.In TAPP group,the peritoneum was opened after pneumoperitoneum,the hernia was then pulled back so that to separate the preperitoneal space and place and nail the MESH.In the TEP group,the preperitoneal space was built by blunt dissection,and then Mesh was placed before gas release.Results The procedures were completed successfully in all the 300 cases without conversion to open surgery.The mean operation time for TAPP and TEP was 44.2 min（30-150 min） and 36.7 min（25-110 min） respectively.No analgesic was used after the procedures.Complications included seroma（12.6%,45/357）,temporary nerve paresthesia（6.4%,23/357）,injury to the inferior epigastric artery（1.1%,4/357）,urinary retention（0.6%,2/357） and injury to the spermatic duct（0.3%,1/357）.The mean postoperative hospital stay was 4.8 d（3-10 d）.The rate of patient taking normal activity in 2 and 4 weeks postoperation was 94.0%（282/300） and 100% respectively.267 patients were followed up for 2-60 months（mean,24.2months）,during which no recurrence was found.Conclusions Both TAPP and TEP are safe and effective for hernia repair.Surgeons may choose any of them following their own experience.

关 键 词：腹腔镜疝修补术 经腹腹膜前补片植入术 完全腹膜外补片植入术 

分 类 号：R656.21[医药卫生—外科学]