提高腹腔镜腹股沟疝手术安全性和有效性的关键环节  

The key points for improving the safety and effectiveness of laparoscopic inguinal hernia repair

作　　者：李健文[1] 乐飞[1] 薛佩[1] LI Jian-wen;YUE Fei;XUE Pei(Department of General Surgery,Ruijin Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院普外科,上海200025

出　　处：《中国实用外科杂志》2025年第1期84-88,共5页Chinese Journal of Practical Surgery

基　　金：上海市医苑新星专科项目资助基金。

摘　　要：腹腔镜腹股沟疝修补术(laparoscopic inguinal hernia repair,LIHR)的安全性是保障其有效性的核心,而有效性则体现在病人获得最佳治疗效果的体验。LIHR的适应证与开放手术基本相同,单纯性腹股沟疝推荐TEP或TAPP,复杂性腹股沟疝推荐TAPP或Lichtenstein术。LIHR有数种麻醉方式,建议全身麻醉以提供稳定的手术环境。术中分离层次应掌握壁平面、脏平面和平面转换概念,直疝回纳是腹横筋膜与腹膜前筋膜的分离,而斜疝回纳是腹膜与腹膜前筋膜的分离,其间有精索成分穿过。闭合空腔和减少创面是减少术后血清肿形成的两大要素。轻量大网孔不吸收或部分可吸收补片是目前绝大多数情况下的首选材料,可吸收可降解补片的长效机制有待于进一步的临床证据支持。尽可能避免机械性或穿透性的固定方式。非特殊情况不置放引流。术后腹股沟区局部压迫或佩戴疝气裤可能有助于缓解疼痛和降低血清肿的发生率。The safety of laparoscopic inguinal hernia repair(LIHR)is central to ensuring its efficacy.Its efficacy is primarily defined by the patient's experience of optimal therapeutic outcomes.The indications for LIHR are essentially the same as those for open surgical approaches.The Total Extraperitoneal(TEP)or Transabdominal Preperitoneal(TAPP)technique is recommended for primary inguinal hernias.Meanwhile,for complex inguinal hernias,TAPP or Lichtenstein repair is preferred.LIHR can be performed under various anesthetic modalities,with general anesthesia being the preferred choice to maintain a stable surgical environment.Surgeons should master concepts of parietal plane,visceral plane,and plane transition during the procedure.The reduction of direct hernias involves the separation of the transversalis fascia from the preperitoneal fascia.In contrast,the reduction of indirect hernias requires the separation of the peritoneum from the preperitoneal fascia,with the spermatic cord passing through this space.The two main strategies for minimizing postoperative seroma formation are dead space closure and wound minimization.Lightweighted,non-absorbable,or partially absorbable macroporous mesh is the preferred material.The long-term mechanism of absorbable,degradable meshes still requires further clinical evidence.Mechanical or penetrating fixation techniques should be avoided if possible.Drain placement is not indicated in the absence of specific clinical indications.Postoperative local compression in the inguinal area or wearing hernia support pants may help alleviate pain and reduce the incidence of seroma formation.

关 键 词：腹股沟疝 腹腔镜 安全性 有效性 

分 类 号：R6[医药卫生—外科学]