腹腔镜腹股沟疝修补术704例分析

Laparoscopic inguinal hernia repair(a report of 704 cases)

目的:评价腹腔镜腹股沟疝修补术(LIHR)的安全性和有效性,并探讨术式选择。方法:分析1997年1月至2008年9月行腹腔镜腹股沟疝修补术的704例(825侧)病人的临床资料,其中腹腔内补片修补术(IPOM)4例(4侧),经腹腹膜前修补术(TAPP)330例(384侧),全腹膜外修补术(TEP)370例(437侧)。随访时间1～60个月(中位时间18个月)。结果:手术无中转,平均手术时间为(32.5±15.2)(20～140)min,术后平均住院天数为(2.5±1.3)d,2周和4周内恢复非限制性活动人数比率分别为98.3%(692/704)和100%(704/704),术后无需应用镇痛剂。术后总复发率为0.48%(4/825),3侧为TAPP术后复发(0.78%),1侧为TEP术后复发(0.23%)(P=0.527)。TAPP和TEP的总并发症率分别为11.7%和9.15%(P=0.229);两组前3位并发症依次为血清肿(5.73%比4.58%,P=0.455),暂时性神经感觉异常(3.13%比2.06%,P=0.335)和尿潴留(2.34%比2.06%,P=0.781)。其余4例并发症为:TAPP组有1例戳孔疝和1例麻痹性肠梗阻,TEP组有1例肠道损伤和1例麻痹性肠梗阻。Ⅲ、Ⅳ型疝的血清肿发生率明显高于Ⅰ、Ⅱ型疝(P= 0.005)。结论:LIHR是安全有效的无张力修补方法,手术效果以及术式选择取决于疝的类型及术者的临床经验。

Objective To evaluate the safety and efficacy of laparoscopic inguinal hernia repair （LIHR）, and the choice of technique to be used. Methods The clinical data from 704 patients （825 hernias） undergoing LIHR from January 1997 to September 2008 were retrospectively analyzed. The intraperitoneal onlay mesh（IPOM） procedure was performed in 4 patients （4 hernias）, The transabdominal prepefitoneal （TAPP） procedure in 330 patients （384 hernias）, and totally extraperitoneal（TEP） procedure in 370 patients （437 hernias）. The follow-up period ranged from 1 to 60 months （medium follow-up time 18 months）. Results No conversion to open surgery was required during these operations. The average operating time was （32.5±15.2） （20-140） min, average postoperative hospital stay was （2.5±1.3） d. The percentage of patients returned to normal activity within 2 and 4 weeks were 98.3% （692/704） and 100% （704/704）, respectively. No pain-killer was used after operation. The overall recurrence rate of LIHR was 0.48% （4/825）, with 3 recurrences in TAPP （0.78%） and 1 recurrence in TEP （0.23%） （P=0.527）. The total complication rates were 11.7% and 9.15% in TAPP and TEP, respectively （P=-0.229）. The most common postoperative complications in the TAPP and TEP groups were seroma, （5.73% vs 4.58%, P=0.455）, transient neurapraxia （3.13% vs 2.06%, P=0.335）, and urinary retention （2.34% vs 2.06%,P=0.781）. Other complications included： 1 port-site hernia and 1 paralytic intestinal obstruction in the TAPP group, 1 bowel injury and 1 paralytic intestinal obstruction in the TEP group. The rate of seroma was higher in patients with Type Ⅲ and IV hemias than that in the other types （P=0.005）. Conclusions LIHR is a safe and effective tension-free procedure. The choice of LIHR is mainly based upon the type of hernia and the surgeon＇ s preference：