腹腔镜经腹腹膜前修补术在复发性腹股沟疝治疗中的临床应用

Application of laparoscopic transabdominal preperitoneal approach in recurrent inguinal hernia repair

目的 :探讨经腹腹膜前修补术(TAPP)在复发性腹股沟疝治疗中的临床应用。方法 :回顾性分析2001年1月至2013年12月我院采用TAPP治疗的245例(262侧)复发性腹股沟疝病人的临床资料。262侧复发疝分为4种类型:缝合修补术后复发疝78侧(29.8%),平片修补43侧(16.4%),网栓平片修补107侧(40.8%),腹膜前修补34侧(13.0%)。结果:缝合和平片修补术后复发疝均通过TAPP完成治疗,无中转;网栓平片修补术后复发疝中有2侧TAPP中转为腹腔内补片植入术(IPOM)(1.9%);腹膜前修补术后复发疝中有12侧中转为IPOM(35.3%)。平均手术时间为(38.7±13.7)min(含对侧初发疝修补时间),术后无病人应用镇痛剂,术后第1天平均疼痛分数为2.5±0.9,术后平均住院(1.6±1.2)d,2周内全部恢复非限制性活动。1例于术后6个月复发(0.4%)。术后累计并发症发生27例(11.0%),依次为血清肿17例(7.0%),尿潴留6例(2.4%),暂时性神经感觉异常3例(1.2%),麻痹性肠梗阻1例(0.4%)。结论:TAPP是治疗复发性腹股沟疝的有效术式,具体操作可根据前次手术方式,对肌耻骨孔或腹壁缺损进行修补。对于腹膜前修补术后复发疝,术前需做好行IPOM的准备。

Objective To investigate the clinical application of laparoscopic transabdominal preperitoneal（TAPP）approach for recurrent inguinal hernia repair. Methods From January 2001 to December 2013, 245 patients with 262 recurrent inguinal hernias treated by TAPP approach in our hospital were retrospectively enrolled and clinical data were analyzed. The 262 recurrent inguinal hernias could be divided into four types, with 78 recurrent hernias after suture repair（29.8%）, 43 after Lichtenstein repair（16.4%）, 107 after plug and patch repair（40.8%）, and 34 after preperitoneal repair（13.0%）. Results All cases with recurrent hernias after suture repair and Lichtenstein repair were operated by TAPP technique. No convention case was present. Two cases with recurrent hernia after plug and patch repair were converted into intraperitoneal onlay mesh（IPOM） repair（1.9%）, and 12 cases after preperitoneal repair converted into IPOM repair（35.3%）. The average operation time was（38.7 ±13.7） min（including the elapsed time for contralateral primary hernia repair）. No patients required analgesics postoperatively. The postoperative average VAS was（2.5 ±0.9） on the first day postoperative. The mean postoperative hospital stay was（1.6±1.2） days. All patients returned to usual activities in 2 weeks after surgery. One recurrence was found on 6 months postoperative（0.4%）. The postoperative cumulative complications were observed in 27 cases（11.0%） including 17 cases with seroma（7.0%）, 6 cases with urinary retention（2.4%）, 3 cases with transient neurapraxia（1.2%） and 1 case with paralytic ileas（0.4%）. Conclusions TAPP is an effective approach in the treatment of recurrent inguinal hernia. Repair of the myopectineal orifice or the hernia defect can be selected according to the previous operation type. For recurrent hernia after preperitoneal repair, it should be prepared when IPOM approach may be for some cases.