腹股沟疝腹腔镜下全腹膜外补片植入术入路探讨（附35例报告）

Exploration to surgical approach of totally extraperitoneal laparoscopic hernioplasty

目的探讨完全腹膜外腹腔镜腹股沟疝修补术（TEP）的最佳手术入路。方法回顾性分析2006年10月至2007年10月完成TEP者35例，其中斜疝30例，直疝5例。全部采用三孔法，即两个操作孔，一个进镜观察孔，共开辟了4种手术入路，如正中途径腹直肌后鞘与腹直肌之间，正中途径腹膜与腹直肌后鞘之间，侧途径腹直肌后鞘与腹直肌之间，侧途径腹膜与腹直肌后鞘之间。结果手术全部成功，无中转开腹或经腹腔腹膜前修补手术。手术时间40—190min，平均75min。术后无需使用镇痛剂，住院时间4～7d，平均5d。惟一并发症为阴囊血肿1例，未行引流而自行吸收。随访3～15个月，无术后复发。结论TEP是一种成熟的疝修补技术，且复发率低、并发症发生率低。应根据每位患者的不同体质，按照最小损伤的原则，TEP尽可能采用正中途径腹膜与腹直肌后鞘之间入路。

Objective To discuss the best surgical approach for totally extraperitoneal laparoscopie hernioplasty （TEP）. Methods Retrospective analysis the 35 patients with inguinal hernia were treated with TEP from 2006 to 2007. Of the 35 cases, 30 cases were indirect inguinal hernia,5 cases were direct inguinal hernia. Four surgical approaches including the midline approach between the rectus muscle and the posterior rectus sheath,the midline approach between the peritoneum and the posterior rectus sheath, the lateral approach between the rectus muscle and the posterior rectus sheath, the lateral approach between the peritoneum and the posterior rectus sheath. Results All cases were operated on successfully without conversion to open surgery or TAPP. The mean operating time was 75 （40 - 190 ） rain. The average postoperative hospital stay was 5 （3 -7） days. No patient required postoperative analgesics. The only complication was seroma formation which occurred in one patient retrieved without requiring drainage. All the patients were followed up for 3 - 15 months with no recurrence. Conclusions TEP is a mature technique and may be safely performed with low complication and recurrence rate. Considering the whole - body constitution of each patient, according to the principles of ＂Minimally Invasive Surgery＂, the surgeon should select the midline approach between the peritoneum and the posterior rectus sheath as far as possible.