腹腔镜腹股沟疝修补术463例分析

Laparoscopic inguinal hernia repair: report of 463 cases

目的评价腹腔镜腹股沟疝修补术的安全性和有效性。方法分析2001年1月至2007年8月行腹腔镜腹股沟疝修补术的463例(534例次)患者的临床资料,其中IPOM4例(4例次),TAPP192例(219例次),TEP267例(311例次),随访时间2～36个月(中位时间19个月)。结果手术无中转,术后复发率为0.37%(2/534),前3位并发症依此为血清肿5.24%(28/534),暂时性神经感觉异常3.93%(21/534)和尿潴留2.25%(12/534),Ⅲ型、Ⅳ形腹股沟疝的术后并发症率高于Ⅰ型、Ⅱ型腹股沟疝;平均手术时间为(43.3±14.2)min(20～140 min),术后平均住院天数为(3.3±1.2)d,2周和4周内恢复非限制性活动人数分别为97.4%(451/463)和100%,术后无需应用镇痛剂。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术者的临床经验。

Objective To evaluate the safety and efficiency of laparoscopic inguinal hernia repair, and to discuss the use of this technique. Methods The clinical data of 463 patients (534 procedures) who had undergone laparoscopic inguinal hernia repair between January 2001 and August 2007 were retrospectively analyzed. Four IPOM procedures were performed in 4 patients, 219 TAPP procedures in 192 patients, and 311 TEP procedures in 267 patients. All of the patients were followed up for 2-36 months with a median of 19 months. Results No conversion was done. The recurrence rate was 0.37%(2/534). Hematoma /seroma,transient neurapraxia and urinary retention ranked as the most common postoperative complications whose incidences were 5.24%(28/534), 3.93%(21/534) and 2.25%(12/534) respectively. The incidences of postoperative complications were clinically higher in III and IV hernias than in other types. The operating time was (43.3±14.2) min (20-140 minutes). The postoperative hospital stay was (3.3±1.2) days. All patients resumed normal activities in 2 and 4 weeks, accounting for 97.4%(451/463) and 100% respectively. No patients were given any antalgic. Conclusions LIHR is a safe and efficient tension-free technique. The clinical effectiveness and the selection of approach to laparoscopic inguinal hernia repair depend mainly on the experience of surgeons.