经腹腹膜前腹腔镜腹股沟疝修补术(TAPP)502例

Laparoscopic Transabdominal Preperitoneal Hernia Repair(TAPP):Report of 502 Cases

目的探讨经腹腹膜前腹腔镜腹股沟疝修补术（1aparoscopic transabdominal preperitoneal hernia repair，TAPP）的手术效果。方法2003年3月～2009年8月，行TAPP手术502例（包括双侧110例），合并胆囊病变18例，慢性阑尾炎1例，同时行腹腔镜胆囊或阑尾切除术。建立CO2气腹后，剪开腹膜并横断疝囊，于腹膜前置入聚丙烯网状补片固定，闭合腹膜。结果本组502例均治愈出院。主要并发症有腹股沟区血肿或积液7．6％（38／502），尿潴留20．7％（104／502）。479例随访6—86个月，平均32.6月，其中226例〉24个月。近期（术后1个月内）复发1例，远期复发2例，总的复发率为0．6％（3／479）。结论TAPP治疗腹股沟疝是安全有效的，并发症及复发率可以接受。

Objective To evaluate the efficacy of laparoscopic transabdominal preperitoneal hernia repair （IAFF）. Methods Through March 2003 to August 2009, 502 patients （ including 110 cases of bilateral hernias） received TAPP in our hospital. Among the cases, cholecystic diseases was complicated in 18 patients, and chronic appendicitis in 1, so laparoscopic cholecystectomy or appendectomy were performed at the meanwhile on these patients. To carry out TAPP, we cut the peritoneum and the hernial sac after CO2 pneumoperitoneum, and then fixed polypropylene mesh before closing the peritoneum. Results All the 502 cases were cured. The major complications included liquid accumulation or hematoma at the inguinal region [ 7.6% （38/502） ] and urine retention [20. 7% （104/502）], respectively. Follow-up was achieved in 479 of the cases for 6 -86 months （mean, 32.6 months, 〉 24 months in 226 cases）. During the follow-up, we found short-term recurrence （within one months postoperatively） in one patient, and long-term recurrence in two; the overall recurrence rate was 0.6% （3/479）. Conclusions TAPP is safe and effective with acceptable recurrence and complication rates.