腹腔镜疝囊高位结扎及脐正中襞覆盖治疗成人腹股沟疝(附35例报告)

Laparoscopic high ligation and median umbilical fold onlay for adult inguinal hernia

目的探讨腹腔镜疝囊高位结扎及脐正中襞覆盖加强腹后壁治疗成人腹股沟疝的可行性。方法2003年1月～2005年8月,应用腹腔镜疝囊高位结扎及脐正中襞覆盖疝环口加强腹后壁治疗35例腹股沟疝(其中嵌顿疝5例,双侧疝12例,复发疝8例)的手术后恢复情况及随访结果,并与传统开放手术治疗30例腹股沟疝的结果相比较。结果35例均在腹腔镜下完成。腹腔镜组手术时间[(20.8±8.8)minvs(53.5±12.6)min,t=-12.262,P=0.000]和术后住院时间[(5.5±1.8)dvs(8.5±1.9)d,t=-6.529,P=0.000]均短于传统组。腹腔镜组无阴囊水肿,传统组为36.7%(11/30)(χ2=15.448,P=0.000)。随访(18.6±8.9)月,传统组2例复发,腹腔镜组无复发(χ2=0.691,P=0.406)。结论腹腔镜疝囊高位结扎及脐正中襞覆盖加强腹后壁治疗成人腹股沟疝安全可行,恢复快,不易复发。

Objective To study the feasibility of laparoscopic high ligation and median umbilical fold onlay for the treatment of adult inguinal hernia. Methods Laparoscopic high ligation and median umbilical fold onlay was performed in 35 cases of adult inguinal hernia （including 5 cases of incarcerated hernia, 12 cases of bilateral hernia, and 8 cases of recurrent hernia） from Janaury 2003 to August 2005. Surgical outcomes ad follow-up records were compared with those from another 30 cases of inguinal hernia treated by conventional surgery. Results The laparoscopic operation was successfully performed in all the 35 cases. As compared with conventional surgery, laparoscopic operation presented a shorter operation time （20.8 ± 8.8 min vs 53.5 ± 12.6 rain; t =- 12. 262, P = 0. 000） and postoperative hospital stay （5.5 ± 1.8 d vs 8.5 ± 1.9 d ; t = - 6. 529, P = 0. 000）. Edema of scrotum was not found in laparoscopic cases but occurred in 11 out of 30 conventional cases （36.7% ; X^2 = 15. 448, P = 0. 000）. Follow-up examinations for 18.6 ± 8.9 months found 2 cases of recurrence after conventional surgery and no recurrence after laparoscopic operation （X^2 = 0. 691, P = 0. 406 ）. Conclusions Laparoscopic high ligation and median umbilical fold onlay is safe and feasible in the treatment of adult inguinal hernia.