腹腔镜下免钉合完全腹膜外疝修补术临床应用体会

Without laparoscopic stapling and dual mesh overlap totally extraperitoneal laparoscopic mesh repair of hernia clinical effects

目的：根据腹股沟区解剖特点，探讨腹腔镜下不钉合及双网片交叠的完全腹膜外疝修补术（TEP）的技术要点及安全性、有效性。方法回顾性分析我科2010年1月至2012年12月行腹腔镜下完全腹膜外疝修补术共248例的临床资料，均补片免钉合固定行双网片交叠，术后进行随访。其中，腹股沟斜疝200例，腹股沟直疝48例；单侧疝210例双侧疝38例。结果全部病例均成功施行TEP，平均手术时间30~102 min，单侧平均时间63 min，双侧98 min。并发症主要为阴囊血清肿28例，术后疼痛9例。住院时间为5~11 d，平均住院6 d。随访时间为6~30个月，术后均无复发。结论免钉合及双网交叠的 TEP 术式安全可靠且操作简单，具有术后疼痛少、复发率低、恢复快、腹壁切口美观的优点应值得推广。

Objective To investigate the anatomical characteristics of the inguinal region and the clinical effect without laparoscopic stapling and dual mesh overlap totally extraperitoneal laparoscopic mesh repair of hernia （TEP）. Methods From January 2010 to December 2012, 248 patients was took without laparoscopic stapling and dual mesh overlap totally extraperitoneal laparoscopic mesh repair of hernia, 200 patients were inguinal hernia, 48 patients were inguinal hernia, 210 patients were unilateral and 38 patients were bilateral hernia. Postoperative all patents were follow-up and analyzed the clinical data retrospectively. Results All patients were successfully implemented TEP, the average operation time was 30min to 102min, the average time of unilateral was 63min, average time of bilateral was 98min. The complications consequences of 28 patients had scrotum seroma, 9 patients had postoperative pain. The hospital stay was 5 to 11 day; the average hospital was 6 day. Follow-up time was 6 to 30 months, no recurrence after surgery. Conclusions Without laparoscopic stapling and dual mesh overlap totally extraperitoneal laparoscopic mesh repair of hernia（TEP） was safe, reliable and have advantages such as less postoperative pain, the lower recurrence rate, fast recovery, aesthetic advantages abdominal incision .TEP can achieve good clinical result, should be widely applied.