经脐单部位微型腹腔镜经腹腹膜前疝修补术的临床应用

Clinical application of microlaparoscopic TAPP in umbilicus

目的探讨经脐单部位微型腹腔镜经腹腹膜前疝修补术(TAPP)在临床应用中的可行性、安全性、实用性及操作简便性。方法本院自2015年开始实施经脐单部位微型腹腔镜下TAPP术共71例,随机抽取传统无张力疝修补术100例,比较两组手术时间、术中出血量、术后切口疼痛、切口美观满意度、阴囊血肿、切口感染率、抗生素使用率及术后住院时间。经脐单部位微型腹腔镜下TAPP术中全部使用巴德3D Max补片修补,传统无张力疝修补术补片规格不一。结果两组患者均获成功。经脐单部位微型腹腔镜下TAPP组在手术时间(单侧40±5 min vs 50±5 min,双侧60±5 min vs 100±5 min)、术中出血量(单侧5±2 mL vs 10±2 mL,双侧8±2 mL vs 20±2 mL)、术后切口疼痛、切口美观满意度、抗生素使用率(单侧21.5%vs 0%,双侧100%vs 0%)、术后住院时间(3±1 d vs 8±1 d)明显优于传统无张力疝修补术组(P<0.05),切口感染率及阴囊血肿基本相同。随访2±0.5年,期间无疝复发及其他并发症发生。结论经脐单部位微型腹腔镜下TAPP术,解剖清晰,操作简单,具有临床操作可行性、安全性、实用性及简便性等优点,值得临床推广。

Objective To investigate the feasibility, safety, practicality and ease operation of micro laparoscopic surgical TAPP umbilical single parts in clinical application. Methods Seventy-one cases were performed with umbilical TAPP micro laparoscopic operation in our hospital since 2015. A total of 100 cases without tension hernia repair were randomly chosed. The operation time, intraoperative blood loss, postoperative incision pain, satisfaction of incision, scrotal hematoma, incision infection, antibiotic usage and postoperative hospital stay were compared between 2 groups. TAPP micro laparoscopic surgery by umbilical single parts were repaired by bud in 3 d Max patch.Traditional cases without tension hernia repair patch had different specifications. Results Two groups of patients achieved surgical success. Operation time, intraoperative blood loss, postoperative incision pain, aesthetic satisfaction, antibiotic usage of incision, postoperative hospital stay in the umbilical single parts micro laparoscopic TAPP group is superior than that of the traditional group, with same incision infection rate and scrotal hematoma. During followed-up years（2 ± 0.5）, there were no recurrence of hernia and other complications. Conclusion The umbilical single site TAPP micro laparoscopic surgery have a clear anatomy, simple operation, clinical operation feasibility. It is worth of clinical promotion with safety, practicality and simplicity.