腹腔镜经腹腔腹膜前疝修补术218例报告

Laparoscopic transabdominal preperitoneal herniorrhaphy:a report of 218 cases

目的：探讨成人腹股沟疝行腹腔镜经腹腔腹膜前疝修补术（transabdominal preperitoneal,TAPP）的安全性、实用性及简便性。方法：为218例成人腹股沟疝患者行TAPP,术中将操作加以改良。环形切开内环口周围腹膜并向头侧方向分离腹膜瓣,常规游离腹壁下血管、精索血管及输精管,将补片一侧剪开后穿过并包绕腹壁下血管、精索血管及输精管,钉夹固定补片,用扳直的圆针1-0可吸收线外荷包缝合内环口周围腹膜瓣一周后收紧打结。结果：218例手术均获成功,手术时间平均（50±15）min,术后2-4 d出院,出血量5-10 ml。术后8例发生外环口皮下积液或积血,经穿刺抽液、抽血后痊愈;2例肠麻痹,经对症处理后痊愈;无疝复发及其他并发症发生。结论：此术式治疗成人腹股沟疝操作更简便,更美观,分离腹股沟管后内侧壁间隙更容易,便于置入足够大的补片,利于防止术后复发,更符合腹股沟管缺损的解剖要求,修补更牢固,可显著降低术后复发率。

Objective： To discuss the safety,practicality and convenience of laparoscopic transabdominal preperitoneal prosthesis（ TAPP） in the treatment of adult inguinal hernia. Methods： Two hundred and eighteen cases of adult inguinal hernia underwent TAPP,and the intraoperative operation were improved. The peritoneum around the internal ring was cut and dissected towards the head,the inferior epigastric vessel,the spermatic vessels and the ductus deferens were routinely freed,one side of the hernia patch was cut,the hernia patch was put through and wrapped around the inferior epigastric vessel,the spermatic vessel and the ductus deferens,fixed with the clips,the peritoneum around the internal ring was purse string sutured with the 1-0 absorbable suture. Results： All of the 218 cases of operation were successful. The mean operative time was（ 50 ± 15） min,the postoperative hospital stay was 2-4 d,the intraoperative blood loss was 5-10 ml. Subcutaneous effusion or hematocele around the external ring occurred in 8 cases and recovered after puncture and drainage. Enteroparalysis was found in 2 cases and recovered after symptomatic treatment. No recurrence or other complications occurred. Conclusions： This operation is more artistic and convenient in the treatment of adult inguinal hernia. This operation is easier to dissect the space in the posterior medial wall of the inguinal canal and put big enough patch. It is beneficial to prevent recurrence and more accords with the anatomic requirement for the defect of the inguinal canal. This repairment is stronger and could significantly reduce recurrence rate.