无钉合完全腹膜外腹腔镜疝修补术的临床体会(附67例报告)

Clinical experience of unstapled technique in laparoscopic totally extraperitoneal inguinal hernia repair: with a report of 67 cases

目的：探讨无钉合腹腔镜完全腹膜外疝修补术（totally extraperitoneal,TEP）治疗腹股沟疝的临床疗效及手术技巧。方法：回顾分析2010年5月至2013年5月在全身麻醉下为67例患者行无钉合腹腔镜TEP的临床资料,患者平均（57.2±18.04）岁,其中男65例,女2例,双侧腹股沟疝8例,斜疝46例,直疝13例。结果：3例术中因腹膜破裂中转开腹,余者均顺利完成手术。手术时间平均（130.5±15.8）min,术后平均住院（4.5±1.2）d,恢复日常活动时间平均（5.2±1.3）d。术后无阴囊血肿等并发症发生。随访1-36个月,复发1例,无腹股沟区慢性疼痛。结论：无钉合腹腔镜TEP是可行、安全、有效的无张力疝修补术,疗效确切可靠,适于推广应用。

Objective： To explore the therapeutic effect and the surgical skill of unstapled techniques in laparoscopic totally extraperitoneal（ TEP） inguinal hernia repair. Methods： The clinical data of 67 patients whose average age was（ 57. 2 ± 18. 04） years,including 65 males and 2 females,who were performed unstapled TEP under general anesthesia from May 2010 to May 2013,were retrospectively analyzed. In all,there were 8 cases of bilateral inguinal hernia,46 cases of indirect hernia,and 13 cases of direct hernia（ 5cases combined with indirect hernia in them）. Results： Three cases were converted to open operation because of rupture of peritoneum and others were performed unstapled TEP repair successfully. The mean operation time was（ 130. 5 ± 15. 8） min,the mean postoperative hospital stay was（ 4. 5 ± 1. 2） d and the mean recovery daily activities time was（ 5. 2 ± 1. 3） d. There were no appearances of complications such as hematocele after operation. The recurrence was found in 1 case and no persistent nervous pain occurred during a following up of 1 to 36 months after operation. Conclusions： Unstapled TEP repair is a feasible,safe,reliable and effective technique for tension-free hernia repair,and is suitable for promotion and application in municipal medical institutions