腹腔镜下腹股沟疝手术失败后再手术原因分析

Reason analysis of reoperation after failed laparoscopic inguinal hernia operation

目的：分析腹股沟疝患者行腹腔镜手术失败的原因，探讨腹腔镜腹股沟疝手术中应注意的事项。方法回顾性分析2003年8月至2013年1月间收治的17例腹股沟疝行腹腔镜手术后失败再手术患者的临床资料。结果再手术原因：复发9例，补片感染1例，小肠漏1例，肠壁疝1例，线结反应2例，膀胱损伤1例，脐部切口裂开1例，阴囊血肿1例，髂血管损伤1例。6例再次行腹腔镜探查手术，11例行开腹手术，所有患者均手术成功，术后2～15 d痊愈出院。结论腹腔镜技术应用于腹股沟疝时，在严格掌握腔镜手术指征和遵循手术操作规范。对于病情特殊，手术有难度者应及时中转开腹。术后应密切注意并发症的发生，及时处理并发症。

Objective To analyze the reasons and notes of failed laparoscopic surgery for patients with inguinal hernia.Methods The clinical data of 17 cases of failed laparoscopic inguinal hernia opera-tion from August 2003 to January 2013 in our hospital were reviewed retrospectively.Results The reasons of reoperation included 9 cases of recurrence,1 case of patch infection,1 case of intestinal fistula,1 case of intestinal wall hernia,2 cases of suture reaction,1 case of bladder injury,1 case of ruptured umbilical inci-sion,1 case of scrotal hematoma and 1 cases of iliac vascular injury.Six patients received repeated laparo-scopic surgery and the other patients were treated with open surgery.All patients were successfully treated and discharged after 2-15 days.Conclusion When the laparoscopic technique is applied for inguinal her-nia,indications of laparoscopic surgery should be strictly controlled and operation standard should be fol-lowed.For patients with special condition,difficult laparoscopic operation should be timely converted to laparotomy.Close attention needs to be paid to the occurrence of postoperative complications and they need timely treatment.