腹腔镜腹股沟疝修补术并发症及其对策

Complications of laparoscopic inguinal herniorrhaphy and follow-ups

目的探讨腹腔镜腹股沟疝修补术(LIHR)并发症的原因及预防对策,提高手术安全性。方法回顾性分析合肥市第二人民医院2010年3月至2012年12月收治的93例LIHR的临床资料,其中经腹腹膜前补片植入术(TAPP)58例(64侧),完全腹膜外疝修补(TEP)35例(38侧),对术中、术后并发症的发生原因进行分析。随访1～30个月,中位时间18个月。结果所有手术均获成功,无中转。平均手术时间(64.2±13.6)min,术后平均住院时间(4.3±1.3)d。术后主要并发症为阴囊血(清)肿5例(5.3%)、暂时性感觉神经障碍4例(4.3%)、尿潴留3例(3.2%)。结论减少LIHR手术并发症,其对策是以预防为主,首先应合理选择LIHR术式,关键是要熟悉肌耻骨孔和腹膜前间隙解剖结构,并且术者要进行专业化和规范化操作培训。

Objective To decrease the incidence of complications and improve the safety of laparoseopie inguinal herniorrhaphy. Methods From March 2010 to December 2012, the clinical data in a total of 93 patients who were performed with laparoscopie inguinal herniorrhaphy were reviewed respectively. Of all, there were 64 cases of transabdominal preperitoneal inguinal hernia repair （TAPP） in 58 patients and 38 cases of total extraperitoneal inguinal hernia repair （TEP） in 35 patients. The causes of complications during or after operation were analyzed. The cases were followed-up for 1 to 30 months with a median of 18 months. Results The operations were completed successfully in all of the 93 cases without conversions to open surgery. No recurrence was observed. The seroma （hematoma）, transient neurapraxia and urinary retention were the most common postoperative complications, their incidences were 5.3%, 4.3% and 3.2% respectively. The operating time was （64.2 ~ 13.6 ） mins, The postoperative hospitalization stay was （4.3 ~ 1.3 ） days. Conclusions In order to decrease the rates of complications, the adaptation of laparoseopic inguinal herniorrhaphy should be controlled stricdy. The follow-ups are taken to prevent before the operations. It is the key that the anatomy of myopectineal orifice and the preperitoneal space should be thoroughly understood, and should be performed with specialized training and standardized operations.