腹腔镜探查并一期经腹腹膜前疝修补术治疗腹股沟嵌顿疝

Laparoscopic exploration and one-stage transabdominal preperitoneal herniorrhaphy in the treatment of inguinal incarcerated hernia

目的:探讨腹腔镜探查一期经腹腹膜前疝修补术(transabdominal preperitoneal,TAPP)治疗腹股沟急性嵌顿疝的可行性及安全性。方法:2014年6月至2015年12月收治13例腹股沟急性嵌顿疝患者,均为手法复位失败者。采用气管插管,腹腔镜探查同期行TAPP。监测患者的手术时间、术中出血量、中转开腹情况、补片及腹腔感染、住院时间,并与对照组160例常规腹股沟疝修补术患者进行对比研究。结果:12例腹股沟急性嵌顿疝患者均在腹腔镜下成功完成一期TAPP。1例因肠坏死,疝修补后中转开腹行坏死小肠切除术;3例肠管肿胀缺血,观察15 min,肠管血运改善,肠蠕动恢复。术后无一例发生补片感染及严重并发症,患者均康复出院,随访至今,未见复发。结论:TAPP治疗腹股沟急性嵌顿疝安全、可行,疗效可靠。

Objective：To explore the feasibility and safety of the laparoscopic exploration and first-phase laparoscopic transab- dominal prepefitoneal （TAPP） hernia repair for acute incarcerated inguinal hernia. Methods： From Jun. 2014 to Dee. 2015,13 patients of acute incarcerated inguinal hernia with failure of manual diaplasis underwent laparoscopic exploration and TAPP under general anes-thesia with endotracheal intubation. The operation time,intraoperative bleeding, conversion to open surgery, patch and abdominal infection and hospital stay were monitored and analyzed, and compared with the control group of conventional inguinal hernia repair （ n = 160）. Results ：Twelve patients of acute incarcerated inguinal hernia successfully underwent laparoscopic TAPP. Open bowel resection after TAPP was performed for another case with bowel necrosis. For 3 cases of intestinal swelling and ischemia, no bowel resection was performed after intestinal blood supply improvement and intestinal peristalsis recovery in 15 min observation. All patients recovered and were discharged without any postoperative patch infection or serious complications. No recurrence was found during follow-up. Conclusions ：TAPP is safe ,feasible, effective and reliable in the treatment of acute incarcerated inguinal hernia.