腹腔镜腹股沟疝修补术在青年患者中的应用特点  

Application characteristics of laparoscopic inguinal hernia repair in young patients

作　　者：李健文[1] 乐飞[1] Li Jianwen;Yue Fei(Department of General Surgery,Ruifin Hospital,Shanghai Jiaotong University School of Medicin;Shanghai Minimally lavasive Surgery Center,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院普通外科上海市微创外科临床医学中心,200025

出　　处：《中华消化外科杂志》2018年第11期1080-1082,共3页Chinese Journal of Digestive Surgery

基　　金：吴阶平医学基金临床科研专项资助基金（320.6750.14321）

摘　　要：腹腔镜腹股沟疝修补术（LTHR）是应用腹腔镜行腹膜前修补术，具有术后疼痛轻、恢复非限制性活动快，美观等特性，对于青年患者是较好的手术方式。对于经验丰富的外科医师，可选择全腹膜外修补术或经腹腹膜前修补术（TAPP），对于复杂疝、初学者等，建议选择TAPP。青年男性患者多为先天性斜疝，可合并精索静脉曲张、隐睾等先天性疾病。精索静脉曲张可在LIHR中同时处理。隐睾应根据不同情况在LIHR前就制订处理方案。对于有切除指征的隐睾，位于腹腔或内环口处的隐睾可在LIHR中切除。青年男性嵌顿性阴囊疝多见，可采用杂交手术治疗。青年女性患者需注重股疝的处理。如合并子宫圆韧带囊肿，多数患者可以在腹腔镜下完整切除。如条件允许，青年女性患者建议保留子宫圆韧带，内环口成形和T形腹膜切开两种技术可供选择。Laparoscopic inguinal hernia repair （LIHR） is a surgical procedure of preperitoneal repair under laparoscope. It is well suited for young patients due to the advantages of postoperative slighter pain, faster resuming non restrictive activities and better cosmetic effect. Total extraperitoneal and transabdominal preperitoneal （TAPP） are alternative for experienced surgeons and TAPP is recommended for complicated hernias or beginners. Most of the inguinal hernias in young males are congenital indirect hernias, accompanied with varicocele or cryptorchid. Varicocele can be handled simultaneously during LIHR and treatment scheme for cryptorchid should be formulated before LIHR according to different situations. Cryptorchid located in abdominal cavity or inner mouth can be resected in LIHR for resectable cryptorchid. Incaecerated scrotal hernia is common in young males and can be treated by hybridization technique. Femoral hernia should be paid attention in young females. Femoral hernia of most patients can be excised completely under laparoscope if combined with cyst of uterus round ligament. If possible, young females are suggested to preserve round ligament of uterus. Keyhole surgery and T-dissection are available for selected.

关 键 词：疝 腹腔镜腹股沟疝修补术 青年患者 男性 女性 

分 类 号：R656.21[医药卫生—外科学]