腹腔镜完全腹膜外径路腹股沟疝修补术98例

The clinical analysis of 98 patients with totally laparoscopic extraperitoneal herniorrhaphy

目的 探讨影响腹腔镜下完全腹膜外径路腹股沟疝修补术（totally extraperitoneal prosthetic herniorrhaphy,TEPH）成功的因素和应对方法.方法 从2006年10月至2009年5月完成的全部行完全腹膜外腹股沟疝修补术（TEPH）的病例中,选择手术条件和操作内容相同的98例病例作为研究对象进行手术数据分析,总结手术的经验和方法.结果 手术的关键在于腹膜前间隙的建立.单因素方差分析表明在疝囊颈部、中央区、外侧区、底部等不同区域腹膜破裂后,其手术时间之间差异无统计学意义,P〉0.05;而相同部位的腹膜破裂,发生在不同手术时期其手术时间之间差异有统计学意义,P〈0.05.早期的腹膜破裂病例手术时间较发生在中期和晚期的病例,手术中转率高.本组98例均获随访,随访率100%.随访时间3-36个月,中位随访时间18个月.术后1个月有3例患者诉局部不适,2个月后症状消失,术后随访无复发病例及慢性疼痛病例.结论 腹膜破裂是影响TEP手术成功的重要因素,遵循腹膜前间隙空间建立的原则是手术成功的关键.

Objective To evaluate some key steps influencing success rate in process of totally laparoscopic extraperitoneal herniorrhaphy（TEPH）. Methods Between October 2006 and May 2009,we performed totally laparoscopic extraperitoneal herniorrhaphy in 98 patients with like procedures and under the same condition. Results The critical procedures of the operation are related to the establishment of the extraperitoneal cleavage. We used one-way anova analysis. The operation time in different peritoneal burst sites have no significant difference （P 〉 0. 05）, but the operation time in different burst periods have significant difference（P 〈0. 05）. The timing at which the burst occurs significantly influence the length of operation, while the rapture sites don＇t influence the operation time. The conversion rate was higher and operation time was longer between the cases with the rapture occurrence in early period and in mid and late period. Postoperatively 98 patients were followed up. The follow-up rate was 100%. The median follow-up time was 18 months. Three patients complained local discomfort one month after operation, which subsided after 2 months. There was no recurrence or chronic pain case. Conclusion The burst of the peritoneum during the process of establishing extraperitoneal cleavage significantly influences the success rate of TEPH.