改良医用胶黏合假疝囊预防腹腔镜全腹膜外直疝修补术后血清肿临床观察

Clinical observation on the prevention of seroma after laparoscopic totally extra-peritoneal direct hernia repair with modified medical adhesive false hernia sac

目的探讨应用改良医用胶黏合假疝囊技术预防腹腔镜全腹膜外直疝修补术后血清肿的可行性。方法纳入2017年4月至2019年5月西安市中心医院普一科收治的36例腹股沟直疝患者。所有患者采用TEP手术。术中直疝假疝囊均给予改良医用胶黏合预防术后血清肿。结果36例患者,其中男31例,女5例;年龄31~82岁,平均年龄67.5岁;体质量指数17.6~31.5 kg/m^(2);平均体质量指数24.6 kg/m^(2)。其中Ⅱ型疝13例,Ⅲ型疝23例,均为单侧腹股沟直疝;其中右侧疝25例,左侧疝11例。所有手术均顺利完成,无中转腹腔镜经腹腹膜前疝修补术病例,无感染等严重并发症。手术时间36.6~53.2 min,平均用时44.5 min,其中1例因游离弓状线外侧缘时分破腹膜,术中用3-0可吸收线缝合,因而手术时间延长。术中出血1~5 ml,平均3 ml;术后24~36 h下床,平均下床时间30 h;术后1~3 d出院,平均2 d;住院花费1135.42~1269.74元,平均1189.42元。术后经视觉模拟评分进行评估,所有患者术后1d评分为2~5分,平均3.5分。其中2例分别于术后1周和2周出现血清肿,经腹股沟超声检查证实,血清肿发生率为5.56%,1例因较小,未特殊处理,随访3个月后自行消失,1例给予2次局部抽液,3个月后消失。余患者均未出现明显血清肿。结论改良医用胶黏合假疝囊技术预防直疝TEP术后血清肿的技术,方法简便易行,效果可靠,值得推广及进一步研究。

Objective To explore the feasibility of applying modified medical adhesive false hernia sac to prevent seroma after laparoscopic totally extra-peritoneal(TEP)direct hernia repair.Methods From April 2017 to May 2019,36 patients with direct inguinal hernia admitted to Department of Hepatobiliary Hernia and Abdominal Wall Surgery of Xi'an Central Hospital were included.All patients underwent TEP hernia repair.Direct hernia false hernia sacs were given modified medical adhesive to prevent postoperative seroma.Results There were 36 patients,including 31 males and 5 females.Patients aged 31~82 years,with an average age of 67.5 years.The body mass index ranged 17.6~31.5 kg/m^(2),with an average body mass index of 24.6 kg/m^(2).Among them,there were 13 cases of typeⅡhernia and 23 cases of typeⅢhernia,all of which were unilateral direct inguinal hernias.There were 25 cases of right hernia and 11 cases of left hernia.All the operations were successfully completed,there was no case converted to laparoscopic trans-abdominal preperitoneal hernia repair(TAPP),and no serious complications such as infection.The operation time ranged from 36.6 to 53.2 minutes,with an average time of 44.5 minutes.The peritoneum of one patient was ruptured when dissociating the outer edge of arcuate line,and 3-0 absorbable thread was sutured during the operation,leading to prolongation of operation time.Intraoperative bleeding was 1~5 ml,with an average of 3 ml.Patients got out of bed 24 to 36 hours after surgery,with an average time of 30 hours.Patients were discharged 1~3 days after surgery,with an average of 2 days.The hospitalization cost was 1135.42~1269.74 yuan,with an average of 1189.42 yuan.The postoperative visual simulation score(VAS)was used for evaluation.All patients had a VAS score of 2~5 at the first day after operation,with an average of 3.5.Among all patients,2 cases had seroma at 1 week and 2 weeks after operation.The incidence of seroma was confirmed by inguinal B-ultrasound.The incidence of seroma was 5.56%.Seroma of one case disappeared spontaneously after 3 months of follow-up due to its small size and no special treatment.The other case was given partial fluids twice,it disappeared after 3 months.No other patients had obvious seroma.Conclusion The modified medical adhesive false hernia sac is a simple and easy-to-use technique to prevent seroma after TEP,with reliable effect,and worthy of promotion and further research.