前入路腹膜前间隙疝修补术术中损伤12例分析

Intraoperative iatrogenic injury of anterior preperitoneal herniorrhaphy:An analysis of 12 cases

目的探讨行前入路腹膜前间隙腹股沟区疝修补术术中损伤的原因及防治策略。方法回顾性分析2005年1月至2012年6月华中科技大学同济医学院附属协和医院肝胆外科收治的12例行腹膜前间隙腹股沟区疝修补术发生术中损伤病人的临床资料。结果 2例为初发疝病人,10例为局部曾行疝修补的病人。膀胱损伤6例,行术中修补;输精管损伤1例,行结扎横断;腹膜穿破2例,行缝合修补;肠管损伤1例,行缝合修补;腹壁下动脉损伤2例,行术中结扎离断。结论腹膜前间隙疝修补术中损伤多见于局部曾行疝修补的病人。熟悉解剖、精细操作、合理选择入路和修补间隙可减少损伤,及时发现并予相应处理可避免发生严重后果。

Objective To investigate the etiology, prevention and treatment strategies for intraoperative injury of anterior preperitoneal groin hernia repair. Methods The clinical data of 12 cases of intraoperative injury of anterior preperitoneal groin hernia repair admitted between January 2005 and June 2012 in Hepatobiliary Surgery Centre,Union Hospital,Huazhong University of Science and Technology were analyzed retrospectively. Results Two cases were for primary herniorrhaphy. Ten cases had undergone hernia repair at least once before. Among the 12 cases,there was 6 cases of bladder injury repaired during the operation, 1 case of vas deferens injury ligated and transected, 2 cases of peritoneal perforation sutured immediately, 1 case of colon injury repaired during the operation and 2 cases of inferior epigastric artery injury ligated and transected during the operation. Conclusion Intraoperative injury is a rare complication for preperitoneal hernia repair,which occurred more commonly in patients perfomed herniorrhaphy before. Being familiar with the anatomy and operating gently can help doctors to reduce the incidence of injury. Discovering immediately and handling appropriately can help doctors to avoid serious consequences.