腹腔镜下完全腹膜外腹股沟疝修补术中放置负压引流管的临床体会

Clinical experience on placing negative drainage tube in laparoscopic total extraperitoneal prosthetic

目的:探讨腹腔镜下完全腹膜外腹股沟疝修补术(total extraperitoneal prosthetic,TEP)中放置负压引流管的临床价值。方法:TEP术中将一次性负压引流管放置于3D-Max疝补片与腹膜间,外接负压吸引球,吸引出术中积液,消除补片与腹膜间的死腔,使补片与腹膜外间隙紧密贴合。结果:50例患者中47例术中放置负压引流管,术后第3天拔除负压引流管,无并发症发生,患者均顺利出院。3例未放置负压引流管,其中2例发生血清肿,术后7 d穿刺抽液治愈;另1例未发生术后并发症患者顺利出院。结论:负压引流管可有效吸除CO2,消除死腔,并观察有无出血、渗血,防止血清肿发生;负压管可所形成的负压可使补片较紧密地夹合在腹膜与腹横筋膜间,防止补片移动,降低复发率。负压管可引流出多余的术中积液,消除细菌培养基,预防感染。

Objective：To study the clinical value of placing negative drainage tube in laparoscopic total extraperitoneal prosthetic. Methods：A disposable drainage tube with one end attached to a negative pressure attraction sphere was placed between 3 D-Max patch and peritoneum to drain intraoperative hydrops and to eliminate the dead space between them, thus leading to close attachment of the two parts. Results：Drainage tube was placed in 47 of the 50 patients. The tube was removed within 3 days postoperatively, and patients discharged with no complications occurred. Of the 3 cases with no drainage placed,2 cases suffered from seroma, which was cured by puncture and aspiration, 1 case discharged with no complications. Conclusions ： Egative pressure drainage can eliminate CO2 and dead space, and it makes it easy to observe whether haemorrhage, errhysis or seroma exist. The negative pressure formed by the drainage tube can not only decrease recurrence rate by making close attachment, but also prevent infection by draining intraoperative hydrops which is an ideal culture medium of bacteria.