腹腔镜完全腹膜外疝修补术补片免固定方法的研究

The study of laparoscopic totally extraperitoneal prosthesis with non-fixed mesh

目的:探讨腹腔镜完全腹膜外疝修补术(totally extraperitoneal,TEP)中补片免固定的临床应用价值及疗效。方法:回顾分析2009年1月至2013年3月采用补片免固定法腹腔镜TEP治疗86例腹股沟疝患者的临床资料(研究组),观察其手术方法、术式特点、补片免固定的疗效与价值及补片位置,并与同期开放疝环充填式(mesh-plug)疝修补术的92例患者(对照组)进行对比分析。结果:两组患者手术时间、阴囊血肿或积液例数、术后复发率差异无统计学意义(P>0.05),住院时间、一次性耗材费用、切口疼痛例数差异有统计学意义(P<0.05)。结论:补片免固定法腹腔镜TEP不仅适宜腹壁缺损小的疝,也可用于腹壁缺损≥4 cm的直疝、斜疝,其手术指征同疝环充填式疝修补术;多项临床指标优于疝环充填式疝修补术,是疼痛轻微、耗材费用低廉、复发率极低的理想术式。

Objective：To investigate the clinical value and efficacy of laparoseopic totally extraperitoueal （TEP） prosthesis with non-fixed mesh. Methods ： The clinical data of 86 patients who suffered from inguinal hernia and underwent laparoscopic TEP with non-fixed mesh from Jan. 2009 to Mar. 2013 were retrospectively analyzed. The surgical method, surgical characteristics, the efficacy and value of non-fixed mesh,the location of mesh and the comparison with open hernia ring filling （mesh-plug） repair in 92 patients were analyzed. Results：There was no significant difference between the operative time,the number of cases with scrotal hematoma or effu- sion, and the recurrence rate （ P 〉 0.05 ） , while the hospital stay, cost of disposable supplies, the number of cases with incision pain showed statistically significant difference （ P 〈 0.05 ）. Conclusions ： Laparoscopic TEP with non-fixed mesh is not only suitable for her- nia with small abdominal wall defeets, but also suitable for direct/indirect inguinal hernia with abdominal wall defects larger than 4 cm, and the indications should be the same as hernia ring filling hernia repair. Meanwhile ,the laparoscopic TEP with non-fixed mesh is an i- deal surgical procedure with minor pain,low-cost supplies,low recurrence rate and better than hernia ring filling hernia repair.