单中心腹腔镜腹股沟疝修补术4445例

Laparoscopic inguinal hernia repair,4 445 cases from a single institution

目的评价腹腔镜腹股沟疝修补术的临床疗效。方法回顾性分析2001年1月至2015年12月在我院接受腹腔镜腹股沟疝修补术的4445例患者（共5330侧疝）的临床资料，其中经腹腹膜前修补术2125例（2402侧），全腹膜外修补术2306例（2907侧），腹腔内修补术20例（21侧）。5330侧疝中，斜疝3216侧（60．3％），直疝1164侧（21．8％），复发疝399侧（7．5％），复合疝479侧（9．0％），股疝72侧（1．4％）。结果单侧疝手术时间（27．1±8．7）min，双侧手术时间（43．0±11．0）min。术后平均住院天数（1．4±1．1）d。术后严重并发症共3例，分别为戳孔疝、肠管损伤和机械性肠梗阻，其他并发症依次为血清肿250例（4．7％）、尿潴留68例（1.3％）、暂时性神经感觉异常23例（0．4％）、麻痹性肠梗阻3例（0．1％）。中位随访时间51个月，共有13例复发，复发率为0．24％。结论腹腔镜腹股沟疝修补术是一种安全有效的手术方式。

Objective To evaluate the clinical effect of laparoscopic inguinal hernia repair （LIHR） . Methods The clinical data of 4 445 cases （5 530 hernias） who underwent LIHR at Ruijin Hospital from Jan 2001 to Dec 2015 were analyzed retrospectively. 2 125 cases underwent 2 402 trans-abdominal preperitoneal procedure（TAPP）, 2 306 cases did 2 907 totally extraperitoneal （TEP）, and 21 IPOMs in 20 cases. There were 3 216 indirect hernias （60. 3% ）, 1 164 direct hernias （21.8%）, 399 recurrent hernias （7. 5% ） , 479 complex hernias （9. 0% ） , and 72 femoral hernias （1.4%）. The median time of follow-up is 51 months with a range between 7 and 187 months. Results The average operation time was 27. 1 -＋ 8.7 rain for unilateral hernia repair, and 43.0 -＋ 11.0 rain for bilateral hernia repair. The average hospital stay was 1.4±1.1 d. There were 250 seroma （4. 7% ） , 68 urinary retention （ 1.3% ）, 23 transient neuropraxia （0. 4% ） and 3 paralytic obstruction of intestines （0. 1% ）. Severe complications included 1 port site hernia, 1 intestinal injury, and 1 mechanical intestinal obstruction. After a medium follow-up of 5l months, there were 13 recurrent cases （0. 24% ）, including 5 cases after TAPP, 7 after TEP, 1 after IPOM. Conclusion LIHR is a safe and efficient technique for hernia repair.