腹腔镜经腹腹膜前横断疝囊法治疗Ⅲ型腹股沟疝

Transection of hernial sac in transabdominal preperitoneal laparoscopic inguinal herniorrhaphy for type Ⅲ inguinal hernia

目的:探讨经腹腹膜前腹腔镜疝修补术中采用横断疝囊法治疗Ⅲ型腹股沟疝的手术方法及优缺点。方法:将2010年3月至2014年8月收治的120例成人Ⅲ型腹股沟疝患者随机分为两组,其中63例在腹腔镜经腹腹膜前疝修补术中横断疝囊,57例行腹腔镜经腹腹膜前腹股沟疝修补术,比较两组手术时间、肛门排气时间、术中出血量、住院时间、术后并发症(肩部疼痛、会阴疼痛、恶心呕吐、血清肿、阴囊水肿)及2年随访情况(慢性疼痛、鞘膜积液、疝复发等指标)。结果:两组均顺利完成手术,两组患者手术时间[(43.5±7.3)min vs.(55.2±6.6)min]差异有统计学意义(t=5.55,P=0.00),术中出血量、住院时间、术后并发症及随访情况差异无统计学意义(P>0.05)。结论:采用腹腔镜经腹腹膜前横断疝囊的手术方法治疗Ⅲ型腹股沟疝可降低手术操作难度,缩短手术时间,疗效安全、可靠,值得推广应用。

Objective：To investigate the methods and advantages of transection of hernial sac in transabdominal preperitoneal （TAPP） laparoscopic inguinal herniorrhaphy for type Ⅲ inguinal hernia. Methods： From Mar. 2010 to Aug. 2014,120 adult patients with the type m inguinal hernia were randomized into two groups. There were 63 cases using transection of hernial sac in TAPP laparo- scopic inguinal herniorrhaphy （ group transection ） and 57 patients who underwent TAPP laparoscopic inguinal herniorrhaphy （ group TAPP）. The primary endpoints were operation duration, anal exhaust moment, intraoperative bleeding volume, hospital stay, complications after operation （the pain of shoulder, the perineal pain, nausea and vomiting, seroma, edema of scrotum） and follow up of two years （ chronic pain, hydrocele of tunica vaginalis, recurrence ）. Results： The 120 operations were successfully completed. The operation dura- tion of group transection was significantly shorter than group TAPP [ （43.5 ＋ 7.3 ） rain vs. （55.2 ＋ 6.6） min, t = 5.55,P = 0.00 3. There were no significant differences in intraoperative bleeding volume, hospital stay, complications after operation and follow up of two years （ P 〉 0.05 ）. Conclusions ： Transection of hernial sac in TAPP laparoscopic inguinal herniorrhaphy for type Ⅲ inguinal hernia could reduce the difficulty of operation, shorten operation duration, achieve good effect, is safe and reliable and worth the clinical adoption and promotion.