腹腔镜经腹腹膜前疝修补术治疗成人嵌顿性腹股沟疝35例分析  

Analysis of 35 cases of incarcerated inguinal hernia in adults for transabdominal preperitoneal repair

作　　者：杨松海 刘玉海[1] YANG Songhai;LIU Yuhai(Department of Emergency Surgery and Microsurgery in Southern District of First People＇s Hospital of Hefei City that Binhu Hospital of Hefei City,Hefei,Anhui 230011,China)

机构地区：[1]合肥市第一人民医院南区合肥市滨湖医院急诊外科微创外科,安徽合肥230011

出　　处：《安徽医药》2018年第7期1325-1327,共3页Anhui Medical and Pharmaceutical Journal

摘　　要：目的探讨腹腔镜经腹腹膜前疝修补术(TAPP)在成人嵌顿性腹股沟疝中应用的可行性及安全性。方法回顾性分析合肥市滨湖医院2012年12月至2015年12月成人嵌顿性腹股沟疝患者进行TAPP治疗的病例,共35例,均为手法复位失败者,其中因肠坏死中转开放手术6例。统计TAPP治疗病例的手术时间,术中出血量,术后3 d疼痛评分,术后并发症发生例数,包括戳孔感染例数、阴囊积液例数、腹股沟区疼痛例数及复发例数。结果完成TAPP治疗的病例共29例,手术时间(65±8)min,术中出血量(10±3)m L,术后3 d疼痛评分(VAS)在0~1分之间,术后出现戳孔感染0例、阴囊积液7例(24.1%),腹股沟区疼痛2例(6.9%)(VAS>3分),阴囊积液经B超确诊多为血清肿,2例自行吸收,其余5例术后1月后复查,仍有积液,行一次或多次穿刺治疗后完全恢复。术后随访6~24个月,未发现复发疝、阴囊积液或腹股沟区慢性疼痛病例。结论 TAPP在成人嵌顿性腹股沟疝中应用是可行、安全有效的,尤其在间断观察肠管血运情况、明显减轻术后疼痛、降低术后并发症发生率及对侧腹股沟区有无隐匿疝等方面,优势极其明显。Objective To investigate the application offeasibility and safety in Transabdominal preperitoneal（ TAPP） repair for incarcerated inguinal hernia in adults. Methods All 35 cases underwent incarcerated inguinal hernia patients for TAPP in Emergency Surgery and minimally invasive surgery of Binhu Hospital of Hefei City from December 2012 to December 2015 were retrospectively analyzed. All cases were failure to manual reduction and 6 of them were converted to open for intestinal necrosis. The operation time,intraoperative blood loss,pain score of three days postoperative and postoperative complications were collected. Postoperative complication included scrotal effusion,inguinal pain and recurrence. Results 29 cases had been completed for TAPP. the operation time was（ 65 ± 8） min,intraoperative blood loss was（ 10 ± 3） m L,postoperative pain score was between 0 ~ 1. There were no infection of poke holes after three days,7 cases of effusion of scrotum（ 24. 1%）,and 2 cases of inguinal pain（ 6. 9%）. Scrotal effusion was seroma diagnosed by B ultrasonic,2 of which were absorbed automatically,and the other were cured by one or more puncture treatment. There were no recurrent hernia,scrotal effusion,and chronic inguinal pain after 6 ~ 24 months follow-up. Conclusions TAPP for incarcerated inguinal hernia in adults is feasible,safe and effective,especially in the continuous observatingintestinal blood supply,reducingpostoperative pain,reduingc the incidence of postoperative complications andfinding concealed hernia.

关 键 词：疝 腹股沟 疝修补术 腹腔镜检查 成年人 

分 类 号：R656.21[医药卫生—外科学]