腹腔镜腹股沟疝修补术式选择的回顾性分析  

Retrospective analysis on the selection of surgical procedures for laparoscopic inguinal hernia repair

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

机构地区：[1]上海交通大学医学院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》2013年第3期224-228,共5页Journal of Surgery Concepts & Practice

摘　　要：目的:探讨腹腔镜腹股沟疝修补术(laparoscopic inguinal hernia repair,LIHR)的术式选择。方法:回顾性分析2001年1月至2011年12月我院2 056例(2 473侧)接受LIHR病人的临床资料,其中经腹腹膜前修补术(transabdominal preperitoneal,TAPP)871例(1 005侧),全腹膜外修补术(totally extraperitoneal,TEP)1 175例(1 458侧),腹腔内修补术(intraperitoneal onlay mesh,IPOM)10例(10侧)。手术由同组医师完成,中位随访时间42(15～60)个月。结果:TAPP和TEP两组病人的性别、年龄、病程时间、下腹部手术史、疝的分型和类型均有统计学差异(P<0.05)。TAPP组女性病人多于TEP组(P<0.001),年龄小于TEP组(P=0.006),病程时间长于TEP组(P<0.001),有下腹部手术史病人多于TEP组(P<0.001);Ⅳ型疝(81.4%)多于TEP组,Ⅰ型疝(27.4%)、Ⅱ型疝(29.2%)和Ⅲ型疝(44.3%)少于TEP组;股疝(61.1%)和复发疝(81.4%)多于TEP组,斜疝(41.6%)、复合疝(35.0%)和直疝(22.9%)少于TEP组。前3年开展术式以TAPP为主,之后TEP开展比例逐渐上升并超过TAPP。10例IPOM均为复发疝修补。TAPP组中有1例中转行Lichtenstein术,TEP组无中转;TAPP组手术时间(P=0.021)、住院天数(P<0.001)长于TEP组;两组病人的术后视觉模拟疼痛量表评分(P=0.173)、恢复活动人数比例无统计学差异(P=0.479)。TAPP组和TEP组病人术后复发率分别为0.3%和0.2%,无统计学差异(P=0.693);总并发症发生率分别为9.3%和6.6%,差异有统计学意义(P=0.014)。TAPP组有2例发生严重并发症(需要手术干预),分别为戳孔疝和肠梗阻;TEP组有1例,为肠道损伤。结论:TAPP和TEP都是安全、有效的手术方法,TEP可作为首选;对于女性、病程长、有下腹部手术史、巨大难复性疝、腹膜前间隙植入过补片的复发疝病人,可选择TAPP;多次复发者,可选择IPOM。Objective To investigate the choice of approach to laparoscopic inguinal hernia repair(LIHR).Methods The clinical data of 2 056 consecutive patients(2 473 hernias) undergoing LIHR between Jan 2001 and Dec 2011 at our hospital was retrospectively analyzed.There were 1 005 TAPP in 871 cases,1 458 TEP in 1 175 cases and 10 IPOM in 10 cases.All procedures were performed by the same surgical team,and the selection of the techniques was based by the surgeons.The follow-up period ranged from 15-60 months(median 42 months).Results There was significant difference between TAPP and TEP with respect to sex,age,disease duration,history of lower abdominal surgery,hernia type and classification(P<0.05).TAPP was preferable procedure for female(P<0.001),younger patients(P=0.006),and those with longer disease duration(P <0.001) and with history of lower abdominal surgery(P <0.001).TAPP was used more frequently in type Ⅳ(81.4%),while less frequently in type Ⅰ(27.4%)、 type Ⅱ(29.2%) and type Ⅲ(44.3%).TAPP was much more used for femoral hernias(61.1%) and recurrent hernias(81.4%),but less for indirect hernias(41.6%),combined hernias(35.0%) and direct hernias(22.9%).TAPP was the prior procedure in the first 3 years of study,and TEP was more frequently later.IPOM was used in 10 cases all recurrent hernias.One conversion to Lichtenstein was done in TAPP,while no conversion in TEP.The mean operation time(P=0.021) and postoperative hospital stay(P<0.001) were in favor of TEP.No significant difference was found in visual analogue pain scale(P=0.173) and proportion of patients returning to usual activities between TAPP and TEP(P =0.479).The recurrence rate in TAPP and TEP were 0.3% and 0.2% respectively with no significant difference between them(P=0.693).The morbidity of TAPP and TEP were 9.3%,6.6%,

关 键 词：腹腔镜 腹股沟疝 疝修补术 术式选择 

分 类 号：R656.21[医药卫生—外科学]