低气腹压免钉合器固定腹腔镜腹膜外腹股沟疝修补术(附38例报告)

Laparoscopic Extraperitoneal Inguinal Hernia Repair with Low-pressure Pneumoperitoneum without Using Stapling Devices: Report of 38 Cases

目的 探讨低气腹压免钉合器固定腹腔镜腹膜外腹股沟疝修补术的可行性与疗效. 方法 2006年1月～2007年2月,对38例可复性腹股沟疝行腹腔镜下腹膜外修补术,于脐下缘、脐与耻骨联合连线中上1/3及中下1/3处分别穿刺 11 mm、5.5 mm与5.5 mm trocar,腹膜外腔注入低压(6～8 mm Hg)CO2气体,用无损伤抓钳进行腹膜外分离,由脐部至耻骨联合及患侧腹股沟区,建立足够大的手术空间,分离出疝囊及其周围重要结构,大疝囊于颈部结扎后予以横断,疝囊留于原位,小疝囊则完全游离后还纳腹腔.置入补片(12 cm×15 cm)并展开使之平整紧贴腹壁,包括内环口、海氏三角和股环区域,免用钉合器固定补片.术后以沙袋加压术区,保留尿管,绝对卧床24 h. 结果 38例均顺利完成腹腔镜手术,无中转其他术式.手术时间45～85 min,平均56 min,出血5～10 ml.发生血清肿4例,腹膜穿孔2例,无肠管损伤,无皮下气肿及高碳酸血症发生,无术后神经痛及术后再出血.38例随访6～19个月,平均10.5月,无复发. 结论 低气腹压免钉合器固定腹腔镜腹膜外腹股沟疝修补术可行,并发症少,疗效确切.

Objective To investigate the feasibility and effectiveness of laparoscopic extraperitoneal inguinal hernia repair with low-pressure pneumoperitoneum without using stapling devices.Methods A total of 38 patients with reducible inguinal hernia underwent laparoscopic extraperitoneal inguinal hernia repair in our hospital from January 2006 to February 2007.Three abdominal trocars were introduced into the extraperitoneal cavity.An 11-mm trocar was placed at the lower border of the umbilicus,and the other two sized 5.5 mm were at the upper and lower 1/3 of the line between the umbilicus and the pubic symphysis,respectively.Then,low-pressure(6-8 mm Hg) CO2 was insufflated into the extraperitoneal cavity.Non-traumatic forceps was used to create an operative space from the hilum to the pubic symphysis and the diseased inguinal area.The hernia sac and the fabrics around it were disconnected.For big hernia sacs,the sac was ligated,cut at the cervix,and then left at its original site.While for small hernia sacs,it was dissociated and put back into the abdominal cavity.Afterwards,a patch sized 12 cm × 15 cm was placed into the cavity,stretched,and attached to the abdominal wall,covering the annulus inguinalis profundus,Hesselbach triangle,and the femoral ring,without using stapling devices.After the operation,the patients received sandbag compression at the operative area and were kept in bed with urethral catheter for 24 hours. Results The operation was successfully accomplished in all the 38 cases without conversion to open surgery.The operation time was 45-85 min(mean,56 min).The intraoperative blood loss was 5-10 ml.After the operation,seroma occurred in 4 cases,and perforation in 2.No subcutaneous emphysema,hypercapnia,intestinal injury,neuralgia,or hemorrhage was found.The patients were followed up for 6 to 19 months(mean,10.5 months),and no recurrence occurred.Conclusions It is feasible to use laparoscopic extraperitoneal inguinal hernia repair with low-pressure pneumoperitoneum without using stapling devices.The method is associated with few complications and confirmed efficacy.