自制网塞应用于腹腔镜全腹膜外疝修补术方法探讨及临床研究

A discussion and the clinical application of a self-made plug in laparoscopic totally extraperitoneal prosthesis

目的：探讨补片免钉合腹腔镜全腹膜外疝修补术（totally extraperitoneal,TEP）中应用自制网塞填塞腹壁缺损的临床价值及疗效。方法：回顾分析2011年1月至2015年10月收治的96例腹股沟疝患者的临床资料,其中50例行补片免钉合TEP加网塞充填疝修补术（研究组）,46例行单纯补片免钉合TEP疝修补术（对照组）,对比分析两组手术方法、治疗效果、手术指征等临床指标。结果：患者均顺利完成手术。两组手术时间、住院时间、耗材费用、阴囊血肿或血清肿及术后异物感差异无统计学意义（P〉0.05）。随访6-54个月,两组均无术后疼痛及复发病例。结论：网塞充填式TEP不仅适于腹壁缺损〈4 cm的腹股沟疝,更适于腹壁缺损〉4 cm的腹股斜疝与直疝,其临床应用前景及推广价值更高,是安全、实用、较理想的疝修补术式。

Objective： To evaluate the clinical value and therapeutic effect of usage of a kind of self-made plug without nails to repair abdominal wall defect in laparoscopic totally extraperitoneal prosthesis（ TEP）. Methods： Clinical data of 96 inguinal hernia patients in the Shanghai Second People＇s Hospital during the period from Jan. 2011 to Dec. 2015 were retrospectively analyzed. 46 of them were divided into the control group with single TEP and the other 50 patients were in the study group with TEP plus plug. Operative methods,curative effect and operative indicators of the two groups were compared. Results： All patients successfully received the surgery. There were no significant differences between two groups in the operation time,hospital stay,material cost,scrotum hematoma,seroma and postoperative foreign body sensation（ P〈0. 05）. No postoperative chronic pain or recurrence was found during the follow-up of 6-54 months. Conclusions： The indication of TEP with plug includes the inguinal hernia smaller than 4 cm and the indirect and direct inguinal hernia bigger than 4 cm. This procedure is a safe,ideal and practical herniorrhaphy,and worth clinical application and promotion.