腹腔镜经腹腹膜前疝修补术治疗腹股沟疝合并病态肥胖患者的围手术期体会

Perioperative experience of laparoscopic transabdominal preperitoneal hernia repair for inguinal hernia patients complicated with morbid obesity

目的探讨腹腔镜经腹腹膜前疝修补术(TAPP)治疗腹股沟疝合并病态肥胖患者的围手术期干预方法及体会。方法对2012年1月至2016年12月,中国医科大学附属第一医院收治的33例行TAPP术式治疗腹股沟疝合并病态肥胖患者围手术期施以有效的干预治疗。干预主要针对术前由病态肥胖引发的高腹压病因的纠正、术后并发症的处理及护理以及出院后预防复发疝的健康指导。结果本组33例患者平均手术时间(73.2±8.0)min,平均住院(7.0±3.9)d。合并阴囊积液1例,经阴囊抬高、局部皮肤护理并经细针穿刺抽吸等处理后痊愈出院。本组患者术后随访6~24个月,无疝复发及补片感染等远期严重并发症发生。结论对接受TAPP术式治疗的腹股沟疝合并病态肥胖的患者实施围手术期有效的干预治疗,可有效控制并减少并发症的发生,促进患者的痊愈。

Objective To discuss the perioperative intervention methods and experience of laparoscopic transabdominal preperitoneal inguinal hernia repair （TAPP） in patients complicated with morbid obesity. Methods From January 2012 to December 2016, 33 cases of inguinal hernia complicated with morbid obesity underwent TAPP in the First Hospital of China Medical University were enroUed. The Patients were treated with perioperative interventions, which aimed at correction of preoperative high abdominal pressure triggered by morbid obesity, nursing and prevention of postoperative complications, and nursing guidance for recurrence prevention. Results The average operation time of this group was （73.2 ± 8. 0）minutes, and the average hospitalization was （7.0 ± 3.9） days. Scrotal effusion occurred in 1 case, cured by scrotal raise, local skin care and fine needle puncture suction. The patients of this group were followed up for 6 to 24 months after operation, no recurrence of hernia and no mesh infection were found. Conclusion For patients with inguinal hernia complicated with morbid obesity undergoing TAPP, the effective perioperative intervention therapy can effectively control and reduce incidence of complications, and promote the recovery of patients.