腹腔镜腹膜前间隙疝修补术疝囊剥离与横断处理的临床分析

Clinical analysis of hernia sac dissection or transection in laparoscopic trans-abdominal preperitoneal inguinal hernia repair

目的探讨腹腔镜经腹腹膜前间隙疝修补术(TAPP)术中对斜疝疝囊采用完全剥离与横断处理两种方法的效果,及术中怎样选择。方法回顾性分析2014年7月至2015年8月,成都市第五人民医院完成的140例(166例次)男性腹股沟斜疝TAPP患者的临床资料,比较疝囊完全剥离与横断处理方法的平均手术时间(术中疝囊处理手术时间是指自疝囊开始分离至精索腹壁化时间),术中术后并发症,术后复发及住院时间。结果疝囊剥离组中处理疝囊的时间与疝囊大小,疝囊长度,及疝囊与精索是否粘连有关。疝囊长度≤8 cm者,疝囊剥离平均时间(6.2±2.6)min;疝囊长度>8 cm者,疝囊剥离平均时间(24.6±9.8)min;两者之间差异有统计学意义(P<0.05)。疝囊长度>8 cm者,行横断疝囊处理平均时间(9±4)min;而采用完全剥离方法处理疝囊平均时间(25±10)min;两者差异有统计学意义(P<0.05)。术后感染,复发,肠梗阻,住院时间无明显差异。结论疝囊剥离和疝囊横断两种处理方法均安全有效。疝囊长度≤8 cm者,采用完全剥离处理疝囊的方法,手术时间较短,创伤小,恢复快。疝囊长度>8 cm的患者,采用完全剥离疝囊处理方法与采用横断处理疝囊的方法比较,前者手术时间偏长,创伤更大,并发精索损伤概率更高;临床实际工作中可根据情况合理选用。

Objective To determinate a preferable method for handling hernia sac between dissection and transection,we investigated the safety and effectiveness of these two methods in laparoscopic trans-abdominal preperitoneal inguinal hernia repair. Methods The clinical data of 166 operations in 144 male patients who underwent laparoscopic inguinal hernia repair in the Fifth People＇ s Hospital of Chengdu between July 2014 and August 2015 was retrospectively analyzed. We compared the operating time,complication,recurrence,and postoperative hospital stay between the two techniques. The time for handling sac was from splitting sac to perietalization of spermatic cord. Results The dissection group was divided into two subgroups according to the length of hernia sac（ ≤8 cm and 〉8 cm） ： operating time for handling hernia sac was（ 6. 2 ± 2. 6） minutes and（ 24. 6 ± 9. 8） minutes,respectively. The difference was significant. The operating time was associated with the size,length of hernia sac and tissue adhesion. The patients with hernia sac〉 8cm in length were separated into dissection group and transection group. A significant difference was shown in operating time,as the former was（ 9 ± 4） minutes. There were no differences in postoperative infection,recurrence,hospital stay and intestinal obstruction. Conclusion Dissection and transection were both safe and effective techniques. When the length of hernia sac is smaller than 8 cm,dissection has the advantages of minimal injury,less complication,and fewer time expense. If it＇s larger than 8 cm,transection is preponderant.