腹腔镜联合负压引流治疗Ⅰ型巨大腹股沟阴囊疝疗效分析

Analysis of clinical effect of laparoscopic transabdominal preperitoneal approach with negative pressure drainage for type Ⅰ giant inguinal scrotal hernia

目的探讨腹腔镜经腹腹膜前疝修补术(TAPP)联合负压引流治疗Ⅰ型巨大腹股沟阴囊疝(GISH)的安全性和有效性。方法回顾性分析2017年1月至2020年12月在重庆医科大学附属第二医院接受TAPP手术联合负压引流治疗的37例Ⅰ型GISH患者的临床资料,记录术中疝类型、手术时间、术中出血量、术后并发症及复发率等结果。结果37例Ⅰ型GISH患者均顺利完成TAPP手术,术中经阴囊途径于腹膜前间隙留置负压引流管,所有患者无新增辅助穿刺孔及中转开腹。手术时间(147.3±21.8)min,疝环大小(48.6±11.5)mm,术中出血量(31.9±17.3)ml,术后引流时间(7.2±2.3)d,引流量(820.8±138.2)ml,术中无腹腔脏器副损伤。术后3例患者出现轻微并发症,1例为术中损伤腹壁下动脉,1例为术后症状性血清肿,1例为脐部穿刺点感染。出院后平均随访时间13.7个月,无疝复发或补片感染病例。结论TAPP联合负压引流是一种微创治疗Ⅰ型GISH安全而有效的手术方法,但还需要前瞻性、大样本、长期随访结果予以证实。

Objective To investigate the safety and effectiveness of the transabdominal preperitoneal(TAPP)approach with negative pressure drainage in typeⅠgiant inguinal scrotal hernia(GISH).Methods From January 2017 to December 2020,37 patients who underwent TAPP with negative pressure drainage for typeⅠGISH in our hospital were reviewed and retrospectively analyzed.The types of hernia,operative time,intraoperative blood loss,postoperative complications and recurrence rate were recorded.Results All the patients were successfully repaired through the TAPP approach with negative pressure drainage with no additional auxiliary puncture ports or laparotomies.The operative time was(147.3±21.8)minutes.The orifice size of the hernia was(48.6±11.5)mm and the intraoperative blood loss was(31.9±17.3)ml.After operations,the drainage time was(7.2±2.3)days,and the volume of drainage in each patient was(820.8±138.2)ml.No injury of celiac organs occurred during operation.However,minor complications occurred in 3 cases.In one case,the inferior epigastric artery was injured in the operation.A seroma formed in one patient which occurred 2 days after removal of the drainage tube.One patient developed an infection at the site of the umbilical puncture,which was treated by changing the dressing.The mean follow-up was 13.7 months and there was no recurrence or mesh infection during the period.Conclusion TAPP combined with negative pressure drainage is a safe and effective approach for typeⅠGISH with low operative complications.Due to the small sample size of this study,it still required prospective,large-sample and long-term follow-up results to confirm.