腹腔镜全腹膜外疝修补术339例报告

Laparoscopic totally extraperitoneal prosthesis: a report of 339 cases

目的:探讨腹腔镜全腹膜外疝修补术(totally extraperitoneal prosthesis,TEP)的手术技巧与临床效果。方法:回顾分析2009年12月至2012年12月我院为339例患者行腹腔镜TEP的临床资料。结果:334例成功完成手术,2例中转开放手术,3例中转行经腹腹膜前疝修补术。手术时间平均(55±15.2)min,术中出血量平均(6.4±2.0)ml;术中腹膜撕裂19例。术后发生并发症11例,其中术后血清肿6例,阴囊气肿2例,修补区暂时性神经感觉异常2例,尿潴留1例;未发生慢性、持续性神经性疼痛、异物感、补片感染及切口感染。术后平均住院(3.0±0.6)d。术后随访3～24个月,平均(12.4±3.2)个月,2例复发。结论:TEP安全、复发率低、并发症少、痛苦轻、住院时间短、术后康复快,术者需熟练掌握腹股沟区解剖,合理选择手术方式,术中规范操作,以减少术中、术后并发症,提高手术疗效,防止复发。

Objective：To explore the surgical technique and clinical outcome of totally extraperitoneal prosthesis（TEP）.Methods：A retrospective analysis was made on the clinical data of 339 patients who underwent laparoscopicTEP from Dec.2009 to Dec.2012.Results：Two patients were transferred to open operation,3 patients were converted to transabdominal preperitoneal prosthesis,334 operations were successful.The average operative time was（55±15.2） min,the blood loss was（6.4±2.0） ml,the peritoneal tear happened to 19 patients.11 patients had postoperative complications,including serum swelling（6 cases）,scrotal emphysema（2 cases）,transient neurapraxia in the area of repair（2 cases）,and urinary retention（1 case）.No chronic pain,foreign body sensation,infection of patch or incision was found.Average hospitalization time after operation was（3.0±0.6） d,2 cases of recurrence were observed during the follow-up period of 3-24 months,with the average of（12.4±3.2） months.Conclusions：Laparoscopic TEP is safe due to lower recurrence rate and fewer complications.It also has the advantages of less pain,shorter hospital stay and faster recovery.Surgeons should proficiently master the anatomy at inguinal region,reasonably choose operative method,and standardize manipulation,in order to decrease intraoperative and postoperative complications,improve operative effect and prevent recurrence.