腹腔镜下经腹腹膜前疝无张力修补术治疗隐匿性疝的临床研究  

Laparoscopic tension-free repair of abdominal preperitoneal hernia in the treatment of occult hernia

作　　者：田华开 宗振 刘韦东 许添 温华斌 邓小荣[1] Tian Huakai;Zong Zhen;Liu Weidong;Xu Tian;Wen Huabin;Deng Xiaorong(Department of General Surgery,Second Affiliated Hospital,Nanchang University,Jiangxi Nanchang 330006,China)

机构地区：[1]南昌大学第二附属医院胃肠外科,江西南昌330006

出　　处：《腹部外科》2021年第2期115-119,共5页Journal of Abdominal Surgery

摘　　要：目的探讨腹腔镜下经腹腹膜前疝无张力修补术治疗隐匿性腹股沟疝的临床疗效,减少单侧腹股沟疝术后对侧假性复发的发生率。方法回顾性分析南昌大学第二附属医院胃肠外科2017年1月至2019年7月收治的单侧腹股沟疝行手术治疗的2155例病人,其中1105例病人行开放性疝修补术,927例病人行腹腔镜经腹腹膜前疝修补术(transabdominal preperitoneal hernia repair,TAPP),123例病人行腹腔镜完全腹膜外疝修补术(totally extraperitoneal hernia repair,TEP)。术后随访12~30个月,同时观察记录病人手术时间、住院时间、术后并发症以及疝复发率等情况。结果(1)1105例行开放疝修补术病人中,手术时间为(60.8±12.3)min,住院时间为(4.6±1.5)d,101例病人在随访期间复发(同侧复发14例,对侧假性复发87例),对侧假性复发率为7.87%(87/1105),29例病人术后出现伤口感染,36例病人术后出现慢性疼痛;(2)927例行TAPP病人中,手术时间为(45.9±10.1)min,住院时间为(3.1±0.9)d,22例病人在随访期间复发(同侧复发12例,对侧假性复发10例),对侧假性复发率为1.08%(10/927),2例病人出现观察孔感染,16例病人术后出现血肿或血清肿,15例病人术后出现慢性疼痛;(3)123例行TEP病人中,手术时间为(50.8±15.6)min,住院时间为(3.5±1.2)d,5例病人在随访期间复发(圴为对侧假性复发),对侧假性复发率为4.06%(5/123),3例病人中转TAPP,2例病人术后出现血肿或血清肿,3例病人术后出现慢性疼痛。所有病人术中均未出现损伤肠管、输尿管、精索血管等情况。结论TAPP手术应作为单侧腹股沟疝手术治疗的首选术式,该术式有手术时间短、术后恢复快、并发症少等优点。同时,TAPP手术方式能够明显增加隐匿性腹股沟疝的检出率,减少单侧腹股沟疝病人术后对侧腹股沟疝假性复发的风险。另外,对于隐匿性疝建议立即给予预防性的修补,避免病人再次手术。Objective To explore the clinical efficacy of laparoscopic tension-free repair of abdominal preperitoneal hernia in the treatment of occult inguinal hernia and reduce the incidence of contralateral pseudo recurrence after unilateral inguinal hernia surgery.Methods Between January 2017 and July 2019,retrospective analysis was conducted for 2155 patients of unilateral inguinal hernia.There were open hernia repair(n=1105),transabdominal preperitoneal hernia repair(TAPP,n=927)and totally extraperitoneal hernia repair(TEP,n=123).During a postoperative follow-up of(12-30)months,operative duration,hospital stay,postoperative complications and hernia recurrence rate were recorded.Results Among 1105 patients undergoing open hernia repair,operative duration was(60.8±12.3)min,hospital stay(4.6±1.5)days and 101 patients relapsed(ipsilateral recurrence,n=14;contralateral pseudo-recurrence,n=87),contralateral pseudo-recurrence rate was 7.87%,29 patients developed postoperative wound infection and 36 cases had chronic postoperative pain;Among 927 patients undergoing TAPP,operative duration was(45.9±10.1)min,hospital stay(3.1±0.9)days and 22 patients relapsed(ipsilateral recurrence,n=12;contralateral pseudo-recurrence,n=10).The false recurrence rate was 1.08%and there were observation hole infection(n=2),postoperative hematoma or seroma(n=16)and chronic postoperative pain(n=15);Among 123 patients undergoing TEP,operative duration was(50.8±15.6)min,hospital stay(3.5±1.2)days and 5 patients had contralateral pseudo-recurrence.The recurrence rate was 4.06%,3 patients were transferred to TAPP,2 patients developed postoperative hematoma or seroma and 3 patients developed chronic postoperative pain.There was no intraoperative onset of injuries of intestinal tube,ureter or spermatic cord blood vessels.Conclusion TAPP operation should be the first therapeutic choice for unilateral inguinal hernia.This operation offers the advantages of short operative duration quick postoperative recovery and fewer complications.At the same time,T

关 键 词：腹腔镜经腹腹膜前疝修补术 开放式疝修补术 腹腔镜完全腹膜外疝修补术 隐匿疝 假性复发 

分 类 号：R605[医药卫生—外科学]