腹腔镜腹股沟疝修补术2056例报告

Laparoscopic inguinal hernia repair:a report of 2056 cases

目的评价腹腔镜腹股沟疝修补术(LIHR)的临床疗效。方法回顾性分析2001年1月至2011年12月上海交通大学医学院附属瑞金医院普外科2056例(2473侧)行LIHR的临床资料,其中经腹腹膜前修补术(TAPP)874例(1005侧),全腹膜外修补术(TEP)1175例(1458侧),腹腔内修补术(IPOM)7例(10侧)。2473侧疝中,斜疝1481侧(59.9%),直疝525侧(21.2%),复发疝225侧(9.1%),复合疝206侧(8.3%),股疝36侧(1.5%)。疝分型:Ⅰ型疝95侧(3.8%),Ⅱ型疝995侧(40.2%),Ⅲ型疝1157侧(46.8%),Ⅳ型疝226侧(9.1%)。手术由同组医师完成,术式选择由术者决定,随访时间3～60个月(中位时间35个月)。结果 1例TAPP因腹腔广泛粘连中转为Lichtenstein术。病人术后无需应用镇痛剂。2周和4周内恢复非限制性活动率为99.0%和99.9%。共6例复发,复发率为0.24%。TAPP和TEP各3例复发。发生3例严重并发症,分别为戳孔疝、肠管损伤和机械性肠梗阻,其他并发症依次为血清肿129例(5.2%)、尿潴留34例(1.4%)、暂时性神经感觉异常26例(1.1%)、麻痹性肠梗阻3例(0.12%)。结论 LIHR是安全有效的手术,合理选择手术适应证和规范化操作可以获得良好的临床效果。

Objective To evaluate the clinical effect of laparoscopic inguinal hernia repair （LIHR）. Methods The clinical data of 2056 cases （2473 hernias） underwent LIHR between January 2001 and December 2011 at Ruijin Hospital, Shanghai Jiaotong University School of Medicine were analyzed retrospectively. There were 1005 TAPP in 874 cases, 1458 TEP in 1175 cases and 10 IPOM in 7 cases. The 2473 hernias included 1481 indirect hernias （59.9%）, 525 direct hernias （21.2%）, 225 recurrent hernias （9.1%）, 206 complex hernias （8.3%） and 36 femoral hernias （1.5%）. The classification of hernia： there were 95 Type I hernias （3.8%）, 995 type ]I hernias （40.2%）, 1157 type m hernias （46.8%） and 226 type IV hernias （9.1%）. All procedures were performed by the same surgical team and the selection of the techniques was decided by the surgeons. The follow-up period ranged from 3 to 60 months （median 35 months）. Results There was one conversion from attempted TAPP to Lichtenstein repair because of the extensive adhesion. No analgetic was required. Cases returned to usual activities in 2 weeks and 4 weeks accouted for 99.0% and 99.9% respectively. The overall recurrence rate was 0.24% （6/2473）. Both TAPP and TEP had 3 recurrences. There were 3 severe complications： port-site hernia, bowel injury and mechanical intestinal obstruction. Other complications included 129 seroma （5.2%）, 34 urinary retention （1.4%）, 26 transient neurapraxia （1.1%） and 3 paralytic ileus （0.12%）. Conclusion LIHR is a safe and efficient technique. With reasonable selection and standard operation, LIHR can achieve good clinical result.