腹腔镜完全腹膜外疝修补术后并发症的分析(附309例次报告)

Analysis of the postoperative complications of totally extraperitoneal laparoscopic hernia repair: with a report of 309 cases

目的:探讨腹腔镜完全腹膜外疝修补术(totally extraperitoneal,TEP)术后并发症的发生原因及预防措施。方法:回顾分析2010年5月至2012年9月为247例(309侧)患者行TEP的临床资料。结果:247例无一例中转开放手术,9例中转为经腹腔腹膜前疝修补术;术后复发率为1.6%;术后并发症依次为:阴囊水肿/血清肿14例(4.5%)、暂时性神经感觉异常6例(1.9%)、尿潴留4例(1.3%)、慢性疼痛1例(0.3%)、睾丸炎/疼痛1例(0.3%)。结论:完全腹膜外腹腔镜疝修补术是安全、有效的微创术式,降低术后并发症发生率的关键是熟悉腹膜前间隙的解剖、术中规范操作。

Objective ： To explore the causes and prevention of the postoperative complications of totally extraperitoneal laparo- scopic hernia repair （TEP）. Methods ： Clinical data of 247 cases （ 309 sides） TEP from May 2010 to Sep. 2012 were retrospectively analyzed. Results ： All 247 laparoscopic operations were successfully performed without conversion to open surgery. 9 cases were conver- ted to transabdominal preperitoneal prosthesis. The postoperative recurrence rate was 1.6%. The top five postoperative complications were scrota] edema/seroma （ 14/309,4.5% ） , transient nerve paresthesia （6/309,1.9%）, urinary retention （ 4/309,1.3 % ）, chronic pain （1/309,0.3%） and orehitis/testis pain （1/309,0.3%）. No bleeding, mesh infection, visceral injury, small bowel obstruction were observed. Conclusions：The TEP is a safe, effective and minimally invasive surgical method. The key to reduce postoperative com- plication rate is to master the anatomical structure of the preperitoneal space and to be normative during laparoscopic inguinal hernia re- pair.