腹腔镜下腹膜前修补术治疗双侧腹股沟疝17例

Laparoscopic Transabdominal Preperitoneal Approach for Bilateral Inguinal Hernia Repair in 17 Cases

目的：探讨双侧腹股沟疝腹腔镜下腹膜前修补术的效果。方法2011年7月～2012年6月我院行腹腔镜经腹腹膜前双侧腹股沟疝修补术17例，全麻后建立气腹，回纳疝内容物，切开腹膜并分离腹膜前间隙，游离疝囊和腹膜返折，分离耻骨后间隙（ Retzius间隙）和腹股沟后间隙（ Bogrus间隙），将补片完整覆盖双侧的耻骨肌孔，补片的内缘在耻骨联合处重叠，并使用钉枪固定确切，随后关闭腹膜裂口，关闭气腹完成手术。结果17例均成功完成腹腔镜双侧腹股沟疝修补。手术时间73～115 min，平均95 min。术中出血量9～53 ml，平均24 ml。术后疝囊内血清肿1例，皮下穿刺抽吸后包块消失；术后下腹壁疼痛1例，未特殊处理，术后1个月疼痛消失。无补片排异反应，无肠梗阻，肠粘连等发生。16例随访19～26个月，平均22个月，无复发。结论腹腔镜下经腹腹膜前双侧腹股沟疝修补术安全有效，在修复复发疝和巨大疝有独到优势，值得临床推广。

Objective To discuss the efficacy of laparoscopic transabdominal preperitoneal （ TAPP） approach for bilateral inguinal hernia repair . Methods A retrospective analysis was made on clinical data of 17 cases of laparoscopic transabdominal preperitoneal bilateral inguinal hernia repair from July 2011 to June 2012.The pneumoperitoneum was established after general anesthesia .The hernia contents were returned .The peritoneum was opened and the preperitoneal space was separated .Then the hernia sac and peritoneal reflextion were dissociated , and the retropubic space （ Retzius space ） and retroinguinal space （ Bogrus space ） were separated .Patches were used to cover the bilateral myopectineal orifice completely , overlapping the inner edge of the patch in the pubic symphysis , and fixed by using a nail gun .The peritoneum gap was closed and the pneumoperitoneum was removed to finish the operation. Results All the 17 patients successfully underwent laparoscopic hernia repair .The operative time was 73-115 min, with an average of 95 min.The amount of bleeding during operation was 9-53 ml, with an average of 24 ml.One case reported sac seroma, which disappeared after subcutaneous puncture aspiration .One case reported postoperative abdominal pain in repair area , which disappeared after 1 month without special treatment.No rejection, obstruction, or adhesions occurred.Sixteen patients were followed up for 19-26 months （mean, 22 months）, and none reported recurrence . Conclusion Laparoscopic TAPP approach for bilateral inguinal hernia repair is safe and effective ,which has advantages for recurrent hernia and huge hernia repair , being worthy of promotion.