经腹腔完全腹膜外腹股沟疝修补术的临床研究

Clinical Study of Initial Laparoscopic Exploration in Totally Extraperitoneal Prosthetic for Inguinal Hernias

目的:探讨经腹腔完全腹膜外腹股沟疝修补术(TEP)的可行性及优越性。方法:将东莞市桥头医院2014年1月1日至2017年1月31日入院准备择期行完全腹膜外腹股沟疝手术患者60例,随机分为观察组及对照组。观察组行改良TEP。对照组行TEP。观察两组病例手术时间、住院天数、手术中转率、术后并发症、复发率、对侧隐匿疝发现率、合并手术率,并作统计学分析。结果:两组患者均顺利完成手术,观察组合并腹腔镜阑尾切除术3例,合并腹腔镜胆囊切除术1例。随访半年以上,两组均无复发病例。两组患者手术时间、住院天数、术后并发症、复发率等方面比较,差异均无统计学意义(P>0.05),手术中转率、对侧隐匿疝发现率、合并手术率比较,差异具有统计学意义(P<0.05);结论:在行传统TEP时,先进入腹腔探查能减少手术中转率,增加对侧隐匿疝发现率、合并手术率;而无增加手术时间、住院天数、术后并发症、术后复发。

Objective To investigate the feasibility and superiority of initial laparoscopic exploration in totally extraperitoneal prosthetic （TEP）. Methods We were admitted to the hospital from 1st of January 2014 to 31st of January 2017 to prepare for a complete peritoneal inguinal hernia operation with 60 patients, randomly divided into the experimental group and the control group. Experimental group （30 peoples）： Initial laparoscopic exploration in totally extraperitoneal prosthetic for inguinal hernias （modified TEP）. Control group（30 peoples）： totally extraperitoneal prosthetic （TEP）. The surgical time, number of days of hospitalization, he operative transshipment rate, postoperative complications, recurrence rate, the detection rate of the concealed hernia and the combined operation rate of the two groups were observed. Analyze the statistics and draw the conclusion. Result Both groups completed the operation successfully. 3 cases of laparoscopic appendectomy were combined. One case of laparoscopic cholecystectomy was performed. After more than six months of follow-up, there were no recurrent cases in either group. There was no statistically significant difference between the two groups in terms of operation time, number of hospital stays, postoperative complications and recurrence rate（all P 〉 0.05）. There was no statistically significant difference between the two groups in terms of operating transit rate, occlusive herniation rate of the side, rate of combined surgery （all P 〈 0.05）. Conclusion In the traditional totally extraperitoneal, The first entry into the peritoneal probe can reduce the surgical transshipment rate.Increase the detection rate of sited hernia and the rate of combined operation;Without increasing operation time, number of hospital stays, postoperative complications and recurrence. It is worthy of clinic application.