腹腔镜完全腹膜外疝修补术后再次手术原因探讨

Investigation of the reason for reoperation after laparoscopic totally extraperitoneal hernia repair

目的：探讨腹腔镜完全腹膜外疝修补术后再次手术的原因。方法：总结2007年1月以来798例行腹腔镜完全腹膜外疝修补术患者的临床资料,回顾分析导致腹腔镜完全腹膜外疝修补术后二次手术的原因。结果：798例腹股沟疝患者于全麻下行腹腔镜完全腹膜外疝修补术,术后随访3-36个月,共27例患者因术后复发或手术并发症行二次手术,再手术率3.38%。其中12例术后复发,复发率1.50%;11例为腹股沟斜疝疝囊残端血肿或积液（1.38%）;2例腹股沟斜疝于钉合处疼痛（0.25%）;直疝术后疝外被盖突出与脂肪瘤各1例（0.13%）。27例患者再次手术后随访6-36个月,恢复良好。结论：腹股沟疝行腹腔镜完全腹膜外疝修补术后并发症（如巨大阴囊疝腔镜下结扎横断疝囊导致的残端血肿或积液）及术后疝复发是再次手术的主要原因。

Objective： The purpose of this study is to investigate the reason for reoperation after laparoscopic totally extraperitoneal hernia repair. Methods： The clinical data of 798 patients who underwent laparoscopic totally extraperitoneal hernia repair since Jan. 2007 were summarized, the reasons for reoperation after laparoscopic totally extraperitoneal hernia repair were analyzed. Results ： A total of 798 inguinal hernia patients underwent laparoscopic totally extraperitoneal hernia repair. 798 patients were followed up for three months to thirty-six months after operation,27 patients received second surgery, the reoperation rate was 3.38%. 12 cases of inguinal hernia recurred after operation,the recurrence rate was 1.5%. 11 cases of indirect hernia sac stump hematoma or hydrops （ 1.38% ） occurred,2 patients （0.25%） complained pain in the point of nail. 2 direct hernia patients suffered from outstanding covered tissue outside the hernia and lipoma respectively. 27 patients were followed up for six months to thirty-six months after reoperation and all patients well recovered. Conclusions ： The main reasons for reoperation after laparoscopic totally extraperitoneal hernia repair are postoperative complications （ sac stump hematoma or hydrops of huge scrotal hernia） and hernia recurrence.