腹腔镜腹股沟疝修补术136例临床体会

Laparoscopic inguinal hernia repair: the clinical experience of 136 cases

目的:探讨腹腔镜腹股沟疝修补术的手术方式及特点。方法:回顾分析马鞍山市人民医院普外三科2013年10月至2015年6月收治的136例单侧(左/右)腹股沟疝患者的临床资料,患者行腹腔镜手术治疗,其中经腹腹膜前疝修补术(transabdominal preperitoneal,TAPP)83例,全腹膜外疝修补术(totally extraperitoneal,TEP)53例。分析两种腹腔镜疝修补手术方式及特点。结果:136例手术均获成功,未中转开腹。未出现血管、输精管及膀胱损伤。术后发生阴囊血清肿6例,尿潴留11例。手术时间TAPP平均(77.34±18.5)min、TEP平均(85.75±11.9)min。TAPP患者平均住院(4.2±1.6)d,TEP平均(4.5±1.4)d。出血量平均(6.7±2.1)ml。随访半年,均无复发。结论:TAPP手术操作空间较TEP大,技术容易掌握;TEP于腹腔外进行手术操作,保留了腹膜的完整性,但学习曲线较长。TAPP、TEP均安全有效,且较传统无张力疝修补术具有创伤小、康复快、复发率低等特点,适合在有条件的医院普及。

Objective：To investigate the methods and the characteristics of laparoscopic inguinal hernia repair. Methods：The clinical data of 136 patients with unilateral （left/right） inguinal hernia who received laparoseopic surgery from Oct. 2013 to Jun. 2015 were analyzed retrospectively,including 83 cases of transabdominal preperitoneal （TAPP） repair and 53 eases of totally extraperitoneal （TEP） repair. The methods and characteristics of two kinds of ]aparoscopic hernia repair surgery were analyzed. Results：All the 136 operations were successful, none was converted to open operation. There were no injury of blood vessel, deferent duct or bladder. After operations ,6 cases of scrotal seroma and 11 cases of uroschesis occurred. The average time of TAPP was （77.34 ± 18.5 ） rain, and time of TEP was （ 85.75 ± 11.9 ） min. Average hospital stay of TAPP was （4.2 ± 1.6） d and that of TEP was （4.5 ± 1.4） d. The average bleeding volume was （ 6.7 ± 2.1 ） ml. After six months of follow-up, there were no postoperative complications. Conclusions： TAPP operative space is bigger than TEP, and the technology of TAPP is easier than TEP. TEP is a surgery outside of the abdominal cavity, it can maintain the integrity of the peritoneum, but it needs a longer learning curve. Both TAPP and TEP are safe and effective, compared with traditional tension-free repair, they have many advantages, such as small trauma, rapid recovery, low recurrence rate and so on. TAPP and TEP are suitable for popularization in the conditional hospital.