完全腹膜外腹腔镜免气囊免钉合疝修补术112例

Prevention and Treatment of Complication for Laparoscopic Total Extraperitoneal Inguinal Hernia Repair without Fixing Patch:Report of 112 Cases

目的探讨腹股沟疝完全腹膜外腹腔镜疝修补术(total extraperitoneal hernia repair,TEP)的效果。方法 2007年10月～2011年12月112例行TEP,术中充分游离腹膜前间隙,精索或子宫圆韧带骨骼化,平铺补片免钉合。结果手术时间40～162 min,平均83 min。术后住院时间2～7 d,平均4 d。腹股沟区血肿4例,其中3例保守治疗治愈,1例手术清除后治愈;阴囊气肿2例,术后第2天自愈。105例随访1～44个月,平均23个月,其中76例随访>24个月:2例复发,其中1例右侧斜疝术后半年同侧直疝复发,另1例左侧直疝术后3个月复发;术后无腹股沟区慢性疼痛,无粘连性肠梗阻。结论 TEP治疗腹股沟疝安全有效,规范操作并正确把握手术指征对顺利开展TEP具有重要意义。

Objective To explore the efficacy of laparoscopic total extraperitoneal （TEP） inguinal hernia repair. Methods Since October 2007 to December 2011, we performed TEP repair on totally 112 patients with inguinal hernia. The preperitoneal space was separated, and the spermatic cord or the round ligament was skeletonized, so that to place a patch without fixing it. Results The operation time ranged from 40 to 162 min with a mean of 83 min. The mean postoperative hospital stay was 4 days （2 -7 days）. In the patients, four cases were diagnosed with inguinal hematoma, three of them received conservative treatment, and the other one underwent a surgery to removed the lesion; two cases were diagnosed with scrotal emphysema, which was cured spontaneously in the following day. Totally 105 cases received follow-up for 1 to 44 months with a mean of 23 months （ 〉 24 months in 76 cases）, during which no patient complained of chronic pain in the inguinal area or adherent intestinal obstruction; two patients had recurrent hernia, one of them, who had right indirect hernia, developed ipsilateral direct hernia in half a year, and the other one showed recurrent left direct hernia in 3 months after the TEP repair. Conclusions Laparoscopic TEP repair is safe and effective. Standard surgical procedure and strict indications are keys to the operation.