重要作用(附66例报道)腹膜前间隙在腹腔镜TAPP及TEP疝修补术中的

Important Role of Preperitoneal Space in Laparoscopic Transabdominal Preperitoneal and Totally Extraperitoneal Hernia Repair

目的探讨腹腔镜经腹腹膜前(TAPP)和全腹膜外(TEP)疝修补术中腹膜前间隙的重要性。方法回顾性分析2008年1月至2011年4月期间笔者所在医院实施腹腔镜腹股沟疝修补术66例(78侧)患者的临床资料。结果本组行TAPP疝修补术16例(20侧),TEP疝修补术50例(58侧)。3例TEP疝修补术中转行TAPP疝修补术。单侧手术时间(86.92±36.38)min,术中出血(6.08±3.43)ml。术后并发症发生率为16.7%(11/66),其中术后浆液肿3例,修补区暂时性神经感觉异常3例,阴囊气肿2例,尿潴留2例,肠梗阻1例。复发2例。术后住院时间(4.52±0.99)d。出院后(10.32±1.86)d恢复日常活动和工作。66例均获随访,随访时间(18.56±1.96)个月(1～38个月),未观察到补片感染、慢性疼痛、睾丸萎缩等并发症。结论熟悉和掌握腹腔镜下腹膜前间隙及其重要结构,是避免腹腔镜腹股沟疝修补术术中及术后并发症发生的关键。

Objective To explore the important role ofpreperitoneal space in laparoscopic transabdominal preperitoneal （TAPP） and totally extraperitoneal （TEP） hernia repair. Methods The clinical data of 66 patients （78 sides） performed laparoscopic TAPP and TEP hernia repair from January 2008 to April 2011 in this hospital were analyzed retrospectively. Results TAPP hernia repair were performed in 16 cases （20 sides）, TEP hernia repair were performed in 50 cases （58 sides）. Three cases of TEP hernia repair transferred to TAPP hernia repair. The unilateral operation time was （86. 92±36.38） min, intraoperative bleeding was （6.08±3.43） ml. Postoperative complication rate was 16.7% （11/66）, including 3 cases of postoperative serum swelling, 3 cases of temporary paraesthesia of nerve feeling in the repair area, 2 cases of scrotum emphysema, 2 cases of urinary retention, and 1 case of intestinal obstruction. There were 2 cases of recurrence. The hospital stay was （4.52±0. 99） d. The return to activities and working time was （10.32±1.86） d after discharge. Sixty-six cases were followed up for （18.56±1.96） months （range 1-38 months）, the patch infection, chronic pain, and testicular atrophy complications were not been observed. Conclusions Acquainting and mastering laparoscopic preperitoneal space and its important structure are the key to avoid intraooerative and Dostooerative complications of laparoscoDic inguinal hernia reoair.