髂嵴上方入路在腹腔镜完全腹膜外疝修补术中的初步应用体会

Initial discussions on over iliac crest approach of totally extraperitoneal laparoscopic prosthesis

目的:总结经髂嵴上方入路行腹腔镜完全腹膜外疝修补术(totally extraperitoneal prosthesis,TEP)的手术经验,探讨其安全性、可行性、有效性及手术方法。方法:回顾分析2007年3月至2012年10月为16例腹股沟疝患者经髂嵴上方入路行腹腔镜TEP的临床资料,其中直疝3例次,斜疝13例次;双侧疝1例;复发疝3例。结果:16例手术均获成功,手术时间平均(60±20)min,术中出血量平均(15±10)ml,术中未发生肠管及膀胱损伤,术后2例发生血清肿,无术后尿潴留、腹股沟区疼痛及膀胱损伤发生。术后随访1～60个月,无一例复发。结论:经髂嵴上方入路行腹腔镜TEP符合解剖特点,手术安全、有效、可行,成功率高,适应证范围广,切口进一步隐匿化;但术者需具备较丰富的TEP手术经验,更重要的是腹膜前层面正确入路的建立。

Objective： To study and summarize the successful experience, the safety, the feasibility, the practicality, and the op- eration skills of over iliac crest approach of laparoscopically totally extraperitoneal prosthesis （TEP）. Methods ：The clinical data of 16 patients with inguinal hernia performed over iliac crest approach of laparoscopic TEP from Mar. 2007 to Oct. 2012 were analyzed retro- spectively. There were 3 direct inguinal hernias and 13 indirect inguinal hernias. Among 16 patients, 1 patient had bilateral hernias, and 3 patients had recurrent hernias. Results：All operations were successful. The mean operation time was （60 ± 20） min, the mean intrao- perative bleeding amount was （15 ± 10） ml. No iatrogenic intestinal or bladder injury was found during operation. The most common complications were scrotum hematomas and seromas, which appeared in 2 cases. No urinary retention, bladder injury or inguinal pain appeared. All the patients were followed up for 1 to 60 months. There was no recurrence. Conclusions ： Over iliac crest approach of laparoscopic TEP is a safe, effective and feasible surgical approach for inguinal hernia with high operative success rate, broad indications and hidden incision. Surgeons should be experienced in TEP operation, correct approach of preperitoneal layer is very important.