腹腔镜完全腹膜外疝修补治疗腹股沟疝260例报告

Totally laparoscpic extraperitoneal herniorrhaphy:a report of 260 cases

目的探讨完全腹膜外腹腔镜疝修补术（TEP）的安全性、可行性、有效性及手术方法。方法回顾分析2008年9月至2012年3月收治的260例（292侧次）腹股沟疝患者行TEP的临床资料。直疝50侧次,斜疝232侧次,复合疝10侧次。单侧疝240例,双侧疝20例,其中复发疝16例。结果 260例患者共行292侧次TEP。手术时间45-190min,平均单侧50min,双侧120min。术后使用镇痛剂10例。住院时间2-9d,平均（3.0±1.6）d。主要并发症为阴囊血清肿或血肿20例,术后尿潴留18例,腹股沟区疼痛8例,膀胱损伤1例。随访2-40个月,术后复发3例,为早期手术病例。结论 TEP具有安全可靠、术后疼痛轻、恢复快、术后疼痛发生少、远期舒适性好、复发率低等优势,应成为腹腔镜治疗腹股沟疝的主要术式点。

Objective To study and summarize the successful experience, the safety, the feasibility, the practicality and operation skills of totally laproscopic extraperitioneal herniorrhaphy （ TEP ）. Methods Between September 2008 and March 2012,260 patients were performend （292 totally laparoscopic extraperitoneal hernia repars for inguinal hernia ）. Including 50 direct inguinal hernia, 232 indirect inguinal hernia and 10 complex inguinal hernia operations. Among 260 patients, 240 patients had unilateral hernia and 20 patients had bilateral hernias, including 16 recurrent hernia. Results The operation were lasted for 45 to 190 minutes （the mean operating duration was 50 minutes for unilateral hernia and 120 minutes for bilateral hernia）. There were 10 patients need analgesics. The patients stayed in hospital for 2 to 9 days, the mean inpatient hospital stay was （3.0 ± 1.6）days. The mostly complications were scrotum bematomas or seromas, which appeared in 20 cases. Urinary retention appeared in 18 cases. Bladder injury appeared 3 case. Inguinal pain appeared in 8 case. All the patients were followed up for 2-40 months. There was only 3 case of recurrence, which was early case. Conclusions The procedure of TEP is safe, with faster postoperative recover, less pain, lower incidence of pain, better comfort quality and lower recurrence rate. TEP should be the main laparoscopic procedure for inguinal hernia repair.