经腹腔腹膜前疝修补术治疗腹股沟嵌顿疝的治疗体会  

The experience of transabdominal preperitoneal laparoscopic inguinal herniorrhaphy in the treatment of incarcerated inguinal hernia

作　　者：杜汉朋[1] 何永忠[1] 孔凡东[1] 

机构地区：[1]南方医科大学附属何贤纪念医院外二科,广州511400

出　　处：《中华疝和腹壁外科杂志（电子版）》2014年第3期7-9,共3页Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition)

摘　　要：目的：探讨经腹腔腹膜前疝修补术（TAPP）治疗腹股沟嵌顿疝的可行性及有效性。方法回顾性分析2007年9月至2012年8月，南方医科大学附属何贤纪念医院收治的腹股沟嵌顿疝患者100例。观察组50例患者行腹股沟嵌顿疝腹腔镜下复位＋经腹腔腹膜前腹腔镜疝修补术，对照组50例患者行腹股沟嵌顿疝切开复位＋Bassini法腹股沟疝修补术。比较二组患者手术时间、住院时间、下床时间、住院费用和复发率。结果观察组50例患者手术均成功完成，无中转开腹，平均手术时间为（35±11）min，对照组平均手术时间为（44±10）min，二组比较差异无统计学意义（t＝1．62， P＝0．130）；观察组平均住院时间为（5．2±0．9）d，对照组平均为（6．8±1．1）d，二组比较差异有统计学意义（t＝2．30，P＝0．039）；观察组平均下床时间为（12±1）h，对照组平均为（18±1）h，二组比较差异有统计学意义（t＝3．07，P＝0．004）；观察组住院费用多于开放组，二组比较差异有统计学意义（t＝2．11，P＝0．045）；随访12∽36个月，观察组无复发，对照组有8例复发，二组比较差异有统计学意义（χ2＝6．66，P＝0．000）。结论 TAPP是治疗腹股沟嵌顿疝一种安全可靠的手术治疗方法，具有创伤小、疼痛轻、恢复快、操作简单、住院时间短、复发率低等优势，但费用相对较高，临床可根据患者情况适时应用。Objective To investigate the feasibility and effectiveness of transabdominal preperitoneal laparoscopic inguinal hernia repair （TAPP）in clinical practice of incarcerated inguinal hernia. Methods 1 00 cases of incarcerated inguinal hernia in Hexian Memorial Affiliated Hospital of Southern Medical University from September 2007 to August 201 2,were retrospectively analyzed.50 of them,as observation group,were performed with laparoscopic reduction and TAPP.The other 50 patients were treated by open reduction and Bassini procedure as control.Both patient-groups were compared with operation time, hospitalization stay,leave bed time,cost and recurrence rate.Results The operation of 50 cases in observation group were successfully completed,with no open conversion;the mean operation time was （35 ± 1 1 ）minutes in observation group,while in control group was （44 ±1 0 ）minutes,there was no significant difference between two groups（t=1 .62,P=0.1 30）,average hospital stay of observation group was（5.2 ± 0.9）days,which was significantly shorter than that for control group （6.8 ±1 .1 ）days （t =2.30,P=0.039）,mean leave bed time of observation group was（1 2 ±1 ）hours and control group was（1 8 ±1 ）hours, which also reach statistical significance（t =3.07,P=0.004）,Hospitalization costs in observation group were more than the control group （t =2.1 1 ,P =0.045 ）.Follow-up 1 2 to 36 months,there were no recurrences in the observation group,while 8 patients in the control group had hernia recurrence （χ2 =6.66, P=0.000）.Conclusions TAPP is a safe and reliable surgical treatment for incarcerated inguinal hernia, with advantages of minimal invasion,mild pain,rapid recovery,easy manipulation,short hospital stay and low recurrence rate.Despite a relatively high cost,TAPP might be worth promoting in clinical practice.

关 键 词：疝 腹股沟 疝修补术 腹腔镜 对比研究 

分 类 号：R656.2[医药卫生—外科学]