腹腔镜经腹腹膜前修补手术治疗难复性腹股沟疝:附118例分析
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王明刚, Email: wmgonly@126.com

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北京市医管局临床技术创新基金资助项目(XMLX201602)。   


Clinical efficacy of laparoscopic preperitoneal technique in treatment of irreducible inguinal hernia
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    摘要:

    目的:探讨腹腔镜经腹腹膜前修补手术(TAPP)在治疗难复性腹股沟疝的安全性与可行性。
    方法:回顾性分析2011年1月—2016年12月首都医科大学附属北京朝阳医院疝和腹壁外科行腹腔镜TAPP手术的118例难复性腹股沟疝患者手术及随访资料。
    结果:118例患者中,90例(76.3%)行标准TAPP手术,28例(23.7%)行小切口辅助TAPP手术。全组患者手术时间50(40~65)min、术中出血量5(3~10)mL、术后住院时间2(1~3)d、住院费用9 696(9 012~11 456)元。术中并发症4例(3.4%),包括输精管损伤1例(0.8%),精索血管损伤2例(1.7%),腹壁下血管损伤1例(0.8%)。围手术期并发症例31例(26.3%),包括排尿困难8例(6.8%),阴囊血肿1例(0.8%),伤口疼痛21例(17.8%),认知功能障碍1例(0.8%)。患者均完成12个月随访,无复发、感染的病例,随访期内发生并发症48例(40.7%),包括血清肿33例(28.0%),异物感3例(2.5%),慢性疼痛1例(0.8%)。小切口辅助TAPP的患者围手术期伤口疼痛发生率高于标准TAPP患者(46.4% vs. 8.9%,P<0.05),两者其他方面差异均无统计学意义(均P>0.05)。
    结论:在明确诊断的前提下应用腹腔镜TAPP治疗难复性腹股沟疝是安全、可行的,但应视术中情况决定具体手术方式。

    Abstract:

    Objective: To investigate the feasibility and safety of laparoscopic transabdominal preperitoneal (TAPP) repair in treatment of irreducible inguinal hernia. Methods: The surgical and follow-up data of 118 patients with irreducible inguinal hernia undergoing laparoscopic TAPP from January 2011 to December 2016 in the Department of Hernia and Abdominal Wall Surgery of Beijing Chaoyang Hospital were retrospectively analyzed. Results: Of the 118 patients, 90 cases (76.3%) underwent standard TAPP procedure, and 28 cases (23.7%) underwent small incision-assisted TAPP. In the entire group of patients, the operative time was 50(40–65)min, intraoperative blood loss was 5(3–10) mL, length of postoperative hospital stay was 2(1–3) d, and hospitalization cost was 9 696(9 012–11 456) yuan. The intraoperative complications occurred in 4 patients (3.4%), including vas deferens injury in one case (0.8%), spermatic vessel injury in 2 cases (1.7%) and inferior epigastric artery injury in one case (0.8%). Perioperative complications occurred in 31 cases (26.3%), including dysuria in 8 cases (6.8%), scrotum hematoma in one case (0.8%), wound pain in 21 (17.8%) cases and cognitive disorder in one case (0.8%). Twelve months of follow-up was completed in all patients, and no recurrence or infections occurred; complications occurred in 48 patients (40.7%) during period of follow-up, including seroma in 33 (28.0%) cases, foreign body sensation in 3 cases (2.5%) and chronic pain in one case (0.8%). The incidence of perioperative wound pain in patients undergoing small incision-assisted TAPP was higher than that in patients undergoing standard TAPP (46.4% vs. 8.9%, P<0.05), but no statistical differences were observed in other variables between the two procedures (all P>0.05). Conclusion: Laparoscopic TAPP is safe and feasible for the treatment of irreducible inguinal hernia under the premise of a clear diagnosis. However, the procedure should be decided in accordance with the specific conditions during operation.

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刘雨辰, 刘亦婷, 杨硕, 杨慧琪, 王明刚, 秦昌富.腹腔镜经腹腹膜前修补手术治疗难复性腹股沟疝:附118例分析[J].中国普通外科杂志,2018,27(10):1260-1265.
DOI:10.7659/j. issn.1005-6947.2018.10.007

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  • 收稿日期:2018-04-12
  • 最后修改日期:2018-09-17
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  • 在线发布日期: 2018-10-25