腹腔镜完全腹膜外腹股沟疝修补术的临床体会(附312例报告)

Clinical experience of laparoscopic totally extraperitoneal repair for inguinal hernia: with a report of 312 cases

目的:总结腹腔镜完全腹膜外疝修补术(totally extraperitoneal,TEP)治疗腹股沟疝的临床经验,探讨其可行性及临床应用价值。方法:分析2009年1月至2014年1月为312例患者行TEP的临床资料,其中男297例,女15例,平均(58.8±27.5)岁。均为原发疝,无复发疝及嵌顿疝,其中单侧284例,双侧28例,包括斜疝268例、直疝33例、复合疝14例。结果:312例患者均顺利完成手术,无中转开放手术及经腹腹膜前疝修补术,术中无大血管、神经损伤,术后36例出现不同程度的血清肿,13例出现尿潴留,2例复发。手术时间单侧平均(48.4±21.3)min,双侧平均(81.4±40.6)min,术后疼痛时间平均(0.8±0.5)d,术后平均住院(2.4±1.2)d。平均随访(18.2±14.7)个月,未发生慢性疼痛、阴囊血肿、睾丸缺血坏死、网片感染等并发症。结论:TEP具有患者创伤小、康复快、疼痛轻、并发症少、复发率低等优点,安全可行,值得临床推广与应用。

Objective： To summarize the clinical experience of laparoscopic totally extraperitoneal herniorrhaphy（ TEP） in the treatment of inguinal hernia,to explore its feasibility and clinical value. Methods： TEP was performed in 312 cases from Jan. 2009 to Jan. 2014. The clinical data of the 312 patients were analyzed,there were 297 males and 15 females,with the mean age of（ 58. 8 ±27. 5） years. All patients suffered from primary hernia,and recurrent hernia and incarcerated hernia were excluded. 284 cases of unilateral hernia and 28 cases of bilateral hernia were included,in which there were 268 indirect hernia,33 direct hernia and 14 complex hernia. Results： TEP was successfully performed in 312 patients,there was no conversion to open operation or transabdominal preperitoneal approach,major vessels and nerves were not injured. However,36 cases had varying degrees of seroma,13 cases got urinary retention,as well as 2 cases were recurrent. The mean operative time of unilateral hernia was（ 48. 4 ± 21. 3） min,while bilateral hernia was（ 81. 4± 40. 6） min,the mean postoperative pain time was（ 0. 8 ± 0. 5） d,and the average postoperative hospital stay was（ 2. 4 ± 1. 2） d. All patients were followed up for（ 18. 2 ± 14. 7） months,there were no chronic pain,scrotal hematoma,testicular ischemia and necrosis,mesh infection or other complications. Conclusions： TEP is mini-invasive,safe and feasible,has advantages of rapid recovery,little pain,few complications,low recurrence rate and so on,which is worthy of clinical application and popularization.