腹腔镜下经腹腔腹膜前疝修补术处理经plug perix mesh疝修补术后的复发性腹股沟疝87例体会

Clinical Study of Laparoscopic Transabdominal Preperitoneal Inguinal Hernia Repair for Recurrent Inguinal Hernia atfer Inguinal Hernioplasty with Plug Prefix Mesh

目的探讨腹腔镜下经腹腔腹膜前(TAPP)疝修补术处理经plug prefix mesh疝修补术后的复发性腹股沟疝的治疗效果。方法回顾性分析2011年1月至2013年12月期间由我院同一手术医生收治的87例plug prefix mesh疝修补术后复发性腹股沟疝患者行腹腔镜下TAPP疝修补的临床资料(复发疝组),并收集同期由该手术医生收治的834例行腹腔镜TAPP疝修补治疗的初发性腹股沟疝患者的临床资料(初发疝组),观察2组患者的手术时间、术中出血量、术后住院时间,以及术后(1 d、2 d、3 d、30 d)疼痛、血清肿与尿潴留的发生率。结果复发疝组的手术时间及术中出血量均明显多于初发疝组(P=0.000,P=0.000);术后住院时间虽长于初发疝组,但差异无统计学意义(P=0.057)。复发疝组随访时间(31±4)个月,获访率95.4%,获访病例中尚无再复发病例。初发疝组随访时间(28±6)个月,获访率93.6%,获访病例中无复发病例。与初发疝组比较,复发疝组在术后30 d的疼痛发生率(P=0.001)、术后1 d及3 d的血清肿发生率较高(P=0.040,P=0.003),差异有统计学意义;其余观察指标比较差异均无统计学意义(P>0.05)。2组均无副损伤、无明显异物感、无切口感染、无肠梗阻等严重并发症发生。结论腹腔镜下TAPP疝修补术应用于plug prefix mesh疝修补术后的复发疝具有可行性,仔细操作可以避免副损伤等严重并发症;复发疝的手术时间较初发疝为长,出血量稍有增加,血清肿等近期并发症发生率较初发疝高。

Objective To investigate the surgical skills and clinical effects of the laparoscopic transabdominal preperitoneal（TAPP） inguinal hernia repair in treatment of recurrent inguinal hernia with plug prefix mesh. Methods The clinical data such as operation time, intraoperative blood loss, postoperative hospital stay, and postoperative complications of 87 patients with recurrent inguinal hernia reoperated in laparoscopic TAPP after inguinal hernioplasty with plug prefix mesh（recurrent hernia group）, in the Department of Gastroenterology and Hernia Surgery of the First Affiliated Hospital of Kunming Medical University from January 2011 to December 2013,were retrospectively analyzed, which were compared with the 834 incipient inguinal hernia patients operated first by TAPP（incipient hernia group） at the same time. Results The operations were completed successfully in all of the 921 patients without conversion to open surgery. The operation time and intraoperative blood loss in the recurrent hernia group were significantly more than those in the incipient hernia group（P=0.000,P=0.000）, the postoperative hospital stay had no signifcant difference between two groups（P=0.057）. No recurrences were observed in the recurrent hernia group and incipient hernia group for following-up of（31±4） months and（28±6） months, respectively. Compared with the incipient hernia group, the rates of postoperative pain on day 30 and seroma on day 1 and 3 were higher in the recurrent hernia group（P=0.001, P=0.040,P=0.003, respectively）. There were no severe complications such as collateral damage, foreign body sensation, incision infection, intestinal obstruction and so on in the two groups. Conclusions The laparoscopic TAPP inguinal hernia repair is safe and effective for patients with recurrent inguinal hernia with plug prefix mesh. More skills are required to reduce the complications. The operation time and intraoperative blood loss in reoperated patients with recurrent inguinal hernia are more than those in patients with incipient inguinal hernia. The rates of seroma on day 1 and 3 are also higher.