腹腔镜完全腹膜外腹股沟疝修补术的临床体会(附68例次报告)

Clinical experience of laparoscopic totally extraperitoneal inguinal hernia repair: with a report of 68 cases

目的：探讨腹腔镜完全腹膜外疝修补术（totally extraperitoneal,TEP）的手术方法及临床体会。方法：回顾分析2013年8月至2014年8月行68例次TEP的手术经验,回顾总结手术方法、术中关键点、难点及并发症情况。结果：67例次手术获得成功,1例中转腹腔镜经腹腹膜前疝修补术（transabdominal preperitoneal,TAPP）。单侧手术时间40~65 min,平均（48.8±5.25）min,双侧60~115 min,平均（76.3±6.45）min;腹膜破损6例,无腹壁下血管、精索血管、输精管损伤,无一例使用止痛剂及尿潴留发生。术后1~3 d出院,平均（2.7±0.63）d,患者术后第1、3、6个月均获电话随访,2例出现术后远端疝囊血清肿,经穿刺抽吸治疗后好转;无一例复发及发生切口感染、慢性疼痛、内脏损伤、感觉异常等并发症。结论：TEP是目前成人腹股沟疝修补术中较理想的术式,手术操作的要点与难点主要为腹膜外前间隙的建立、镜下解剖标记的辨认与合理应用、疝囊的处理及补片的放置。

Objective： To investigate the operation methods and clinical experience of laparoscopic totally extraperitoneal（TEP） inguinal hernia repair. Methods：The clinical data of 68 cases of laparoscopic TEP from Aug. 2013 to Aug. 2014 were retrospectively analyzed. The operation methods,key operative points,technical difficulties and complications were investigated. Results：Sixtyseven cases were operated successfully,1 case underwent conversion to transabdominal preperitoneal inguinal hernia repair（ TAPP）.The operation time of unilateral TEP ranged from 40 to 65 min,the average was（48. 8 ± 5. 25） min,and that of the bilateral was 60-115 min,the average was（76. 3 ± 6. 45） min. The breakage of the peritoneum in the operation happened in 6 cases,while there was no injury of inferior epigastric vessels,spermatic vessels or vas deferens,and no urinary retention. None of the patients used painkillers. All patients were discharged in postoperative day 1 to 3,the average was（2. 7 ± 0. 63） d,and received telephone follow-ups at the 1st,3rd and 6th month after the operation. 2 cases of postoperative distal hernia sac seroma were found and they recovered after the paracentesis and aspiration treatment. No hernia recurrence or other postoperative complications,such as incision infection,chronic pain,visceral injury or paresthesia occurred in these cases. Conclusions：TEP is an ideal surgical technique in adult inguinal hernia repair. The establishment of extraperitoneal space,identification and taking advantage of anatomic marks via laparoscopy,treatment of hernia sac and placement of the mesh are the key points and technical difficulties during the operative procedure.