腹腔镜与常规手术在嵌顿性腹股沟疝治疗中的应用  

Application analysis of laparoscopy and conventional surgery in the treatment of incarcerated inguinal hernia

作　　者：吴晓华 杨伟锋 王健 黄兴 WU Xiaohua;YANG Weifeng;WANG Jian;HUANG Xing(Department of General Surgery,Nanping First Hospital Affiliated to Fujian Medical University,Fujian,Nanping 353000,China)

机构地区：[1]福建医科大学附属南平第一医院普外科,福建南平353000

出　　处：《中国医药科学》2021年第8期166-169,208,共5页China Medicine And Pharmacy

摘　　要：目的探讨腹腔镜技术在腹股沟嵌顿疝治疗中应用的安全性和有效性。方法选取2017年3月至2019年12月福建医科大学附属南平市第一医院收治的急性嵌顿疝性腹股沟患者64例,其中34例患者采用经腹股沟切口行常规手术治疗,命名为常规手术组A,30例患者采用经腹腔镜腹膜外腹股沟疝修补手术(TAPP)治疗,命名为腹腔镜手术组B。比较两组患者的手术时间、术中出血量、术后住院时间及术后并发症发生率。结果常规手术组A中有4例嵌顿疝患者因小肠发生缺血坏死行部分小肠切除Ⅰ期吻合术,2例因嵌顿部分大网膜发生坏死,予以行大网膜部分切除术,因存在组织坏死,未放置补片,仅行疝囊高位结扎术,常规手术组A手术后有4例发生切口感染,经换药、局部引流后痊愈出院。腹腔镜手术组B患者均无进行中转开放手术,有2例患者因小肠绞窄严重,出现小肠坏死,予以行小肠部分切除Ⅰ期吻合术,仅行内环缝扎处理,手术过程中及术后未出现并发症、无补片继发感染。腹腔镜手术组B的手术时间和住院时间均明显短于常规手术组A,差异有统计学意义(P<0.05)。两组患者术中出血量相当、术后并发症比较差异无统计学意义(P>0.05);腹腔镜手术组B的6个月内复发率低于常规手术组A,差异有统计学意义(P<0.05)。结论经腹腔镜技术治疗急性嵌顿性腹股沟疝是可行的,在基层医院中可以更加安全、有效的的推广,TAPP可作为替代常规开放手术的有效术式应用于临床。Objective To investigate the safety and feasibility of laparoscopic treatment for acute incarcerated inguinal hernia.Methods A total of 64 patients with acute incarcerated inguinal hernia admitted to Nanping First Hospital Affiliated to Fujian Medical University from March 2017 to December 2019 were selected,and they were divided into the conventional surgery group A(n=34)and the laparoscopic surgery group B(n=30).The conventional surgery group A was treated with conventional surgery through inguinal incision,while the laparoscopic surgery group B was treated with transabdominal preperitoneal prosthesis(TAPP).The surgery time,intraoperative hemorrhage volume,postoperative hospitalization time and incidence of postoperative complication were compared between the two groups of patients.Results In the conventional surgery group A,4 patients underwent partial resection and anastomosis of small intestine due to narrow necrosis of small intestine,and 2 patients underwent greater omentum resection due to incarcerated greater omentum necrosis.Because of tissue necrosis,not placing patch,and theonly performance of high ligation of hernia sac was performed,there were 4 patients of incision infection after surgery in conventional surgery group A,and they were discharged after dressing change and local drainage.In the laparoscopic surgery group B,there was no conversion to laparotomy.2 patients underwent partial resection and anastomosis of small intestine due to necrosis of small intestine,only treated with inner ring suture,without intraoperative and postoperative complications and patch infection.The surgery time and hospitalization time of the laparoscopic surgery group B were both significantly shorter than those of the conventional surgery group A,with statistically significant differences(P<0.05).There were no significant differences in intraoperative hemorrhage volume and postoperative complications between the two groups of patients(P>0.05).The relapse rate of the laparoscopic surgery group B within 6 months was low

关 键 词：腹腔镜技术 急性腹股沟嵌顿疝 外科手术 腹股沟疝 

分 类 号：R656.2[医药卫生—外科学]