全腹膜外腹腔镜腹膜前修补术在腹股沟疝中的应用

Laparoscopic repair of lnguinal hernias using a totally extraperitoneal prosthetic approach

在腹股沟疝手术中近些年来发展起来的腹腔镜腹膜前修补术主要包括了经腹膜前修补和全腹膜外修补术。在对耻骨肌孔和腹膜前间隙进行正确认识的基础上,发展起来的全腹膜外修补术术式,可以基本完成类同于开放手术的适应症,同时由于自身的优点:切口小、疼痛轻、对腹腔内器官无干扰、非限制活动时间、恢复早等,并且在处理复发疝和双侧疝上有一定的优势。在脐下做第一孔,不进入腹腔,通过不同的操作途径从腹直肌后鞘开始,游离腹膜后进入腹膜前间隙,在腹横筋膜与腹膜间游离腹膜前间隙。处理疝囊,使精索腹壁化,完成补片的放置和固定。在总体并发症上腹腔镜腹膜前修补术比开放式手术明显低,但是费用相对较高,并且不能适用于所有的患者。通过手术技巧的进步、器械的更新等,该术式必将有更广阔的应用前景。

Laparoscopic extraperitoneal repair of inguinal hernias was developed on the base of the traditional repair of inguinal hernias and included totally extraperitoneal prosthetic （TEP）and transabdominal preperitoneal prosthetic operation（TAPP）. After correct understanding the myopectineal orifice and Bogros space, TEP could complete the basic similar to open surgery indications. At the same time, it had the advantages： small incision, painless, intra-abdominal organs of lighter, the shorter limited activity time, restore early and so on, and had a certain advantages in the treatment of recurrent hernias and bilateral hernia. The first hole was made in the below of the umbilicu, not into the abdominal cavity, through the different operation channel from abdominal rectus sheath to the Bogros space by free retroperitoneal. After treating the hernial sac, letting the spermatic cord closed to the abdominal wall, the polypropylene monofilament mesh was placed and fixed on the MPO. In general the complication of TEP was lower than open surgery significantly, but the anesthesia methods and the relatively high cost made it not appling to all patients. Through the surgical skills be made progress, the progress of the equipment renewal, this operation will have broad prospects in the future.