逆向穿刺法建立腹膜前间隙在腹腔镜全腹膜外疝修补术中的应用

Clinical use of retrograde puncture to create preperitoneal space in laparoscopic totally extraperitoneal herniorrhaphy

目的:探讨腹腔镜全腹膜外疝修补术(totally extraperitoneal,TEP)中采用逆向穿刺法建立腹膜前间隙的方法。方法:2013年5月至2014年5月完成110例腹腔镜TEP,术中采用逆向穿刺法建立腹膜前间隙。结果:1例因穿刺过程中腹膜破损造成气腹改行经腹腹膜前疝修补术,109例建立腹膜前间隙成功。建立腹膜前间隙时间平均(6.0±2.4)min,无血管损伤。术后平均住院(3.0±0.4)d。术后发生局部血肿32例,局部短期内(2周以内)疼痛8例,无长期疼痛病例。结论:腹腔镜全腹膜外疝修补术中采用逆向穿刺法建立腹膜前间隙无需借助特殊器械,操作迅速、安全、可靠,在TEP术中值得应用。

Objective：To discuss a new approach-retrograde puncture that establishes a preperitoneal working space in laparo- scopic totally extraperitoneal herniorrhaphy. Methods： From May 2013 to May 2014, a novel retrograde puncture method was used to construct the preperitoneal space in laparoscopic totally extraperitoneal herniorrhaphy in 110 patients. Results：Except for one patient who was converted to transabdominal preperitoneal surgery as a result of peritoneal damage during retrograde puncture, while the other 109 eases of preperitoneal space were successfully constructed and totally extraperitoneal repair was finished. The average time spent on creating the space was （6.0 ± 2.4 ） min. There was no complications of vascular injury in any of the cases. The average hospitalization time after surgery was （3.0 ± 0.4） d. Of all the 110 cases, there were 32 cases with local hematoma, 8 cases with short period pain within 2 weeks. There were no cases with chronic pain. Conclusions：The retrograde puncture for creating preperitoneal space in laparo- scopic totally extraperitoneal herniorrhaphy could become a new standard method. It is rapid, safe, reliable and can be accomplished without the aid of any special instruments.