腹腔镜探查后行完全腹膜外补片修补治疗急性腹股沟嵌顿疝的临床分析

A clinical analysis of laparoscopic exploration combined with totally extraperitoneal prosthesis in the treatment of acute incarcerated inguinal hernia

目的:总结腹腔镜探查后行完全腹膜外疝修补术(totally extraperitoneal,TEP)治疗腹股沟疝急性嵌顿的优势。方法:2009年5月至2013年5月收治22例急性腹股沟嵌顿疝患者,手法复位成功4例,余18例行联合手术治疗,全麻后先行腹腔镜探查,还纳疝内容物,如无肠管坏死,则转行TEP,术中完整分离疝囊后放置补片。结果:18例手法复位失败的急性腹股沟嵌顿疝患者均成功施行TEP,无一例中转开腹;疝内容物还纳入腹腔轻松、快捷,未出现肠管坏死。5例患者伴肠管缺血,TEP术后再进行腹腔镜探查,观察肠管缺血范围未扩大、缺血程度未加重,未行特殊处理。术后无一例补片感染及严重并发症发生;随访至今,未见复发。结论:TEP治疗急性腹股沟嵌顿疝安全可行,疗效可靠,先行腹腔镜探查可快速评估嵌顿肠管是否存在缺血坏死,应用于老年患者优势明显。

Objective： To summarize the surgical advantages of laparoscopic exploration（ LE） combined with totally extraperitoneal prosthesis（ TEP） in the treatment of acute incarcerated inguinal hernia. Methods： From May 2009 to May 2013,22 patients with acute incarcerated inguinal hernia were involved in this study,and 4 of them received successful manipulative reduction. The rest18 patients underwent LE combined with TEP. After general anesthesia,an exploratory laparoscopy was performed. The incarcerated content was retracted into the abdominal cavity. If no intestinal necrosis was found,the TEP with mesh repair was further performed. Results： All the 18 patients who were failed in manipulative reduction successfully underwent LE combined with TEP with no conversion to open operation. The incarcerated content was easily and rapidly retracted into the abdominal cavity,and no intestinal necrosis was found. 5 patients were found with intestinal ischemia. However,no further treatments were given to these patients as no ischemia progression was found during secondary LE at the end of operation. None case developed mesh infection or severe postoperative complications.According to the follow-up results,no one with hernia recurrence was recorded. Conclusions： LE combined with TEP is safe,feasible,effective and reliable for acute incarcerated inguinal hernia with definite evaluation of intestinal ischemia and intestinal necrosis,especially for elder patients.