腹腔镜经腹腹膜前疝修补术的临床疗效及术后并发症危险因素分析  

Clinical efficacy of laparoscopic transabdominal preperitoneal hernia repair and risk analysis affecting postoperative complications

作　　者：陈昕[1] 徐露[1] 殷骏[1] 胡优[1] 王钢[1] 毛忠琦[1] 周晓俊[1] 

机构地区：[1]苏州大学附属第一医院普通外科,215006

出　　处：《中华消化外科杂志》2017年第9期915-920,共6页Chinese Journal of Digestive Surgery

摘　　要：目的探讨腹腔镜经腹腹膜前疝修补术（TAPP）的临床疗效及影响术后并发症的危险因素。方法采用回顾性病例对照研究方法。收集2008年2月至2016年8月苏州大学附属第一医院收治的595例行腹腔镜TAPP腹股沟疝患者的临床资料。手术由同一组医师完成，患者均行腹腔镜TAPP治疗。观察指标：（1）手术情况。（2）术后情况。（3）随访情况。（4）影响腹腔镜TAPP术后并发症的危险因素分析。采用门诊、电话等方式进行随访。随访内容为恢复非限制性活动时间，术后并发症及疝复发情况。随访时间截至2017年2月。正态分布的计量资料以3f＋S表示。单因素分析采用X。检验，多因素分析采用Logistic回归模型。结果（1）手术情况：595例患者均行腹腔镜TAPP．均使用重型补片。595例患者总体手术时间为（55±25）min，其中502例单侧疝手术时间为（50±20）min，93例双侧疝手术时间为（81±29）min；总体术中出血量为（7±5）mL。595例患者中，嵌顿疝34例，嵌顿内容物为：大网膜21例、小肠11例、乙状结肠2例；嵌顿时间为2～21h；其中4例嵌顿小肠坏死行腹腔镜辅助小肠切除＋吻合术，1例乙。状结肠坏死行坏死肠管切除＋乙状结肠造口术，29例疝内容物复位后行修补术。34例嵌顿疝患者手术时间为（84＋39）min，术中出血量为（12＋6）mL。595例患者中，复发疝13例（斜疝10例、直疝3例），手术时间为（75±26）min，术中出血量为（10±5）mL。（2）术后情况：595例患者术后肛门首次排气时间为（19±12）h。595例患者中，590例术后6h进食流质食物；5例行肠切除术，术后24h进食流质食物。患者术后第1天疼痛指数评分为（2．5±1．4）分，术后住院时间为（2．1±1．9）d。（3）随访情况：595例患者中，593例术后2周恢复非限制性活动，2例术后2周未恢复非限制性活动。542例获得中长期�Objective To explore the clinical efficacy of laparoscopic transabdominal preperitoneal （TAPP） hernia repair and risk factors affecting postoperative complications. Methods The retrospective case- control study was conducted. The clinical data of 595 patients who received laparoscopic TAPP hernia repair in the First Affiliated Hospital of Soochow University from February 2008 to August 2016 was collected. Operations were performed by the same doctors＇ team. Observation indicators： （1） surgical situations; （2） postoperative situations; （3） follow-up situations; （4） risk factors affecting complications after laparoscopic TAPP hernia repair. Follow-up using outpatient examination and telephone interview was performed to detect the recovery time of non-restricted activity, postoperative complications and hernia recurrence up to February 2017. Measurement data with normal distribution were represented as x±s. The univariatc analysis and mukivariate analysis were done using the chi-square test and Logistic regression model. Results （ 1 ） Surgical situations： 595 patients underwent laparoscopic TAPP hernia repair using the heavy meshes. Overall operation time and overall volume of blood loss were （55±25） minutes and （7±5）mL, including operation time of （50±20）minutes in 502 unilateral hernias and operation time of （81±29） minutes in 93 bilateral hernias. Of 595 patients, 34 had incarcerated hernia, the contents of hernia： greater omentum, small intestine and sigmoid colon were detected in 21, 11 and 2 patients, respectively, with an incarcerated time of 2-21 hours; 4 with incarcerated hernia induced small intestinal necrosis received laparoscopy-assisted small intestinal resection ＋ anastomosis, 1 with sigmoid colon necrosis received necrotic sigmoid canal resection ＋ sigmoidostomy and 29 received repair after the contents restoration of hernia. Operation time and volume of intraoperative blood loss in 34 patients with incarcerated hernia were （84 ± 39）minute

关 键 词：疝 腹股沟 经腹腹膜前疝修补术 危险因素 腹腔镜检查 

分 类 号：R656.21[医药卫生—外科学]