腹腔镜经腹腹膜前部分横断疝囊治疗复发腹股沟斜疝的体会

Experience of laparoscopic transabdominal preperitoneal partial transection of hernial sac in recurrent indirect inguinal hernia surgery

目的:探讨腹腔镜经腹腹膜前疝囊部分横断治疗腹股沟复发斜疝的手术技巧及临床应用价值。方法:回顾分析2010年1月至2015年12月为12例复发腹股沟斜疝患者行腹腔镜经腹腹膜前部分横断疝囊手术的临床资料及术后随访,其中原手术行传统巴西尼术8例(男6例,女2例),使用无张力修补术4例(男3例,女1例)。结果:12例复发腹股沟斜疝患者均行腹腔镜经腹腹膜前补片植入术,术中采用部分横断疝囊后完全剥除疝囊的方法,效果良好。手术时间45～90 min,平均(70.0±11.5)min,术后3～5 d出院,平均(4±1)d;术后随访6～24个月,发生阴囊水肿2例,均吸收;1例术后疼痛,经理疗及止痛治疗约1周好转痊愈。目前患者均无复发。结论:腹腔镜经腹腹膜前部分横断疝囊治疗复发腹股沟斜疝在完全剥除疝囊方面具有创伤小、并发症少、缝合腹膜时无张力、复发率低等优势,且手术安全性高,效果可靠,值得临床推广。

Objective： To investigate the surgery technique and the clinical application value of laparoscopic transabdominal preperitoneal partial transection of hernial sac in the treatment of recurrent indirect inguinal hernia. Methods： Retrospective analysis was made on the clinical data and postoperative follow-up of 12 patients who suffered from recurrent indirect inguinal hernia and were treated by laparoscopic transabdominal preperitoneal partial transection of hernial sac from Jan. 2010 to Dec. 2015. Bassini method had been performed in 8 patients （6 males and 2 females） and tension-free hernioplasty had been used in 4 patients （3 males and 1 female）. Results： Twelve patients with recurrent indirect inguinal hernia underwent laparoscopic transabdominal preperitoneal hernia treatment and achieved good results. The hernial sac was completely stripped after partial transection of hernial sac. The operation time was 45-90 min with an average of （70. 0 ± 11. 5） min; the postoperative hospital stay was 3-5 d with an average of （4 ± 1） d. During follow-up of 6-24 months after surgery,2 cases of scrotal edema occurred and gradually recovered; 1 case of postoperative pain recovered after analgesic and physiotherapy for 1 week. No recurrence of hernia was found. Conclusions： Laparoscopic transabdominal preperitoneal partial transection of hernial sac in the treatment of recurrent indirect inguinal hernia has some advantages,such as few trauma and complications,peritoneal suture without tension,low recurrence rate and high operation safety. This method is reliable and worthy of clinical promoting.