腹腔镜全腹膜外疝修补术固定补片方法探讨

Mesh Fixation in Totally Extraperitoneal Prosthesis

目的：探讨腹腔镜全腹膜外疝修补术（totally extraperitoneal prosthesis，TEP）术中经腹壁外穿刺带线结扎固定补片与疝钉枪固定补片的效果。方法将56例择期行TEP术患者按随机数字表法分为A、B 2组，每组28例。2组均行TEP手术治疗，A组采用经腹壁外穿刺带线结扎固定补片；B组采用疝钉枪固定补片。比较2组手术时间、术中出血量、术后下床活动时间、术后住院时间、住院费用及术后并发症（血清肿、切口感染、疼痛、阴囊气肿、复发）发生率。结果所有病例均在腹腔镜下成功完成手术，术后随访6个月～3年，未发现有疝气复发病例。2组手术时间、术中出血量、术后下床活动时间、术后住院时间及术后并发症发生率比较差异均无统计学意义（P＞0.05）；但B组住院费用显著高于A组（P＜0.05）。结论 TEP术中经腹壁外穿刺带线结扎固定补片是一种可行、安全、有效的方法，不仅能有效防止补片移位和卷曲，避免疝复发，而且治疗费用低廉，值得在基层医院推广使用。

Objective To investigate the efficacies of extraperitoneal puncture with suture ligation and hernia nail gun for mesh fixation in totally extraperitoneal prosthesis （TEP ）. Methods Fifty-six patients undergoing elective TEP were randomly assigned to receive mesh fixation with either extraperitoneal puncture and suture ligation（group A, n=28）or hernia nail gun（group B, n=28）. Oper-ation time, intraoperatve blood loss, time to out-of-bed activity, hospital stay, hospital costs and postoperative complications （seroma, incision infection, pain, scrotal emphysema and hernia recurrence） were compared between the two groups. Results The operation was completed successfully under laparoscope in all patients. After 6-36 months of follow-up, no hernia recurrence was found in both groups. There were no significant differences in operation time, intraoperatve blood loss, time to out-of-bed activity , hospital stay , and incidence of postoperative complications between the two groups （ P〉0.05）. Compared with group A, hospital costs significantly increased in group B（P〈0.05）. Conclusion The extraperitoneal puncture with suture ligation is feasible, safe, effective and economical for mesh fixation in TEP, and can prevent mesh shift and curl and avoid hernia recurrence. Therefore, this method is worthy of popularization in basic-level hospitals.