学习曲线内腹腔镜完全腹膜外疝修补术中腹膜破裂的防治  

Prevention and treatment of peritoneal laceration in the laparoscopic totally extraperitoneal hernia repair during learning curve

作　　者：吴立胜[1] 张俊松 余建伟[1] 

机构地区：[1]安徽省立医院普通外科疝及减重代谢外科,合肥230001 [2]安徽医科大学第三附属医院微创外科,合肥230000

出　　处：《中华消化外科杂志》2017年第9期921-925,共5页Chinese Journal of Digestive Surgery

基　　金：国家临床重点专科建设资助项目（201211）

摘　　要：目的探讨学习曲线内腹腔镜完全腹膜外疝修补术（TEP）术中腹膜破裂的情况及处理措施。方法采用回顾性横断面研究方法。收集2012年2月至2017年1月安徽医科大学第三附属医院收治的98例和安徽省立医院收治的22例在主刀医师学习曲线内行腹腔镜TEP腹股沟疝患者的临床资料。患者行腹腔镜TEP，术中补片放置好以后，采用医用胶水固定。观察指标：（1）术中情况：手术方式、手术时间、补片使用情况、术中腹膜破裂情况。（2）术后情况：术后首次排气时间、首次进食流质饮食时间、术后并发症情况、术后住院时间。（3）随访情况：获得随访的患者例数、随访时间、随访期间疝复发、腹股沟区疼痛、肠粘连及肠梗阻引起的腹痛、切口感染情况。患者术后10d内采用电话和门诊随访，术后10d后均采用电话随访。随访内容为术后腹股沟疝复发、腹股沟区疼痛、肠粘连及肠梗阻引起的腹痛、切口感染情况。随访时间截至2017年5月。正态分布的计量资料以面±s表示。结果（1）术中情况：120例患者中，112例施行腹腔镜TEP，5例中转为腹腔镜经腹腹膜前疝修补术（TAPP），3例因疝囊与周围组织粘连紧密，分离时出血而中转开放手术。120例患者总体手术时间为（71±13）min，其中106例单侧疝手术时间为（63±7）min，14例双侧疝手术时间为（79±11）min。120例患者术中均使用补片，补片规格为10．0cm×１5．0cm和16．0cm×10．8cm。120例患者中，48例术中发生腹膜破裂。建立腹膜前间隙时破裂10例，分离腹膜前外侧间隙破裂11例，器械操作不当及疝囊处理时破裂27例。48例腹膜破裂患者中，40例使用气腹针于脐旁刺入腹腔放气继续完成手术，然后行腹膜缝合修补，其中5例复发腹股沟斜疝（前次行组织修补术）主动行疝囊切开后修补腹膜完成手术；8例术中中转其他手术�Objective To explore the causes and managements of peritoneal laceration in the laparoscopic totally extraperitoneal （TEP） hernia repair during learning curve. Methods The retrospective cross-sectional study was conducted. The clinical data of 120 patients with inguinal hernia who underwent laparoscopic TEP hernia repair in the Third Affiliated Hospital of Anhui Medical University （98 patients） and Anhui Provincial Hospital （22 patients） during surgeons＇ learning curve between February 2012 and January 2017 were collected. Patients underwent laparoscopic TEP hernia repair, meshes were intraoperatively placed and then fixed by medical glue. Observation indicators ： （ 1 ） intraoperative situations ： surgical procedure, operation time, using of mesh, intraoperative peritoneal laceration; （2） postoperative situations： time to anal exsufflation, time for fluid diet intake, occurrence of complications, duration of hospital stay; （3） follow-up： number of patients receiving follow-up, follow-up time, recurrence of hernia during follow-up, pain in inguinal region, intestinal adhesion and obstruction induced abdominal pain, incisional infection. Follow-up using outpatient examination and telephone interview within 10 days postoperatively and using telephone interview at 10 days postoperatively was performed to detect the and incisional infection up to May 2017. Measurement data with normal distribution were represented as x±s. Results （1） Intraoperative situations： of 120 patients, 112 underwent laparoscopic TEP hernia repair, 5 convened to laparoscopic trausabdominal preperitoneal hernia repair and 3 converted to open surgery due to adhesion between hernial sac and surrounding tissues induced bleeding of separation. Total operation time of 120 patients was （71± 13）minutes, including （63 ± 7）minutes in 106 patients with unilateral hernia and （79± 11 ）minutes in 14 patients with bilateral hernia. All the patients used intraoperatively meshes of 10.0 cm× 15.0 cm and 16

关 键 词：疝 腹股沟 腹膜破裂 腹腔镜检查 

分 类 号：R656.21[医药卫生—外科学]