成人腹股沟复发疝行腹腔镜经腹膜前间隙修补术疗效分析  

Efficacy analysis of laparoscopic transabdominal preperitoneal repair for recurrent inguinal hernia in adults

作　　者：贾高磊[1] 刘岩 田志龙[1] 高新宝[1] 袁福康[1] 奚海林[1] Jia Gaolei;Liu Yan;Tian Zhilong;Gao Xinbao;Yuan Fukang;Xi Hailin(Department of Vascular&Thyroid&Hernia Surgery,Xuzhou Central Hospital,Xuzhou 221006,Jiangsu,China)

机构地区：[1]徐州市中心医院血甲疝微创外科,221006

出　　处：《中华疝和腹壁外科杂志（电子版）》2020年第6期613-617,共5页Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition)

摘　　要：目的探讨并分析腹腔镜经腹膜前间隙疝修补术(TAPP)治疗成人腹股沟复发疝的临床效果及手术技巧。方法回顾性分析2016年5月至2019年4月于徐州市中心医院血甲疝微创外科行TAPP手术的52例复发性腹股沟疝患者的临床资料。统计并分析患者手术时间、住院时间及术后并发症发生情况等数据。结果所有患者均顺利完成手术,无中转开放。手术用时35~110 min,平均(61.7±13.8)min;术中出血量5~40 ml,平均(13.1±4.7)ml;术后住院时间为1~7 d,平均(2.5±0.9)d;术中误伤腹壁下血管者1例(1.9%),经缝扎止血后好转。术后出现阴囊血清肿者5例(9.6%),3例经保守治疗后治愈,2例经穿刺抽吸后治愈。阴囊及腹股沟区气肿者2例,自行吸收好转。尿潴留者3例(5.8%),经留置导尿管2 d过渡后恢复自行排尿。术区异物感者2例(3.8%),经口服神经营养及止痛药后好转。术后随访6~41个月,无再次复发、补片感染、持续性疼痛、肠梗阻等严重并发症发生。结论TAPP治疗成人腹股沟复发疝具有疗效确切、安全性高、术后恢复好、复发率低的优势,但要求术者必须在熟练掌握腹腔镜技巧、腹股沟区解剖及复发疝的治疗要点的前提下,才能充分发挥TAPP的优势,取得临床最佳疗效。Objective To explore and analysis the surgical techniques and the effect of laparoscopic transabdominal preperitoneal repair(TAPP)in the treatment of recurrent inguinal hernia in adults.Methods The clinical data of 52 patients who underwent laparoscopic TAPP for the recurrent inguinal hernia in Xuzhou Central hospital from May 2016 to April 2019 were retrospectively analyzed.The operation time,hospitalization time and postoperative complications and other data were statistically were analyzed.Results All patients were completed successfully by TAPP and no one was converted to open surgery.The operation time was 35 to 110 min,and the mean operation time was(61.7±13.8)minutes.The intraoperative blood loss was 5 to 40 ml,and the mean blood loss was(13.1±4.7)ml.The postoperative hospital stay was 1 to 7 days,and the mean length of hospital stay was(2.5±0.9)days.One case(1.9%)of inferior epigastric vessel was injured during the operation.There were 5 patients(9.6%)with scrotal seroma after operation,2 patients were cured after puncture and drainage and 3 patients were cured after conservative symptomatic treatment.Two cases of emphysema in the scrotum and groin area were self-absorbed after operation without treatment.Three cases of urinary retention(5.8%)had indwelling catheter after operation,and the catheter was removed in 2 days.There were 2 cases(3.8%)of foreign body sensation in the operation area,which improved after oral nutrition and analgesics.All patients were followed up for 6to 41 months,there were no serious complications such as recurrence,mesh infection,persistent pain,intestinal obstruction after operation.Conclusions TAPP for the treatment of recurrent inguinal hernia in adults has the advantages of definite curative effect,high safety,fast postoperative recovery and low recurrence rate.But at the same time,the surgeon can only fully utilize the advantages of TAPP and obtain the best clinical effect under the premise of proficient in laparoscopic skills,anatomy of the inguinal area,and treatment p

关 键 词：腹腔镜 成人 腹股沟 复发疝 经腹腹膜前疝修补术 

分 类 号：R656.2[医药卫生—外科学]