腹腔镜经腹膜前修补术治疗腹股沟嵌顿疝

Laparoscopic transabdominal preperitoneal herniorrhaphy in treatment of incarcerated inguinal hernia

目的探讨腹腔镜经腹膜前修补术(TAPP)治疗腹股沟嵌顿疝的临床价值。方法回顾性分析2015年1月~2016年12月收治的44例急性腹股沟嵌顿疝的临床资料,按手术方式的不同分为观察组(n=19)和对照组(n=25),观察组采用TAPP术,对照组采用开放腹膜前修补术,比较两组患者的临床疗效。结果两组均成功完成手术。观察组的手术时间、术中出血量分别是60.13±9.52 min和6.00±2.27 mL,对照组分别是60.25±10.71 min和7.25±3.92 mL,两组差异无统计学意义(P>0.05)。观察组术后疼痛VAS评分、术后肠道恢复时间、住院时间分别是2.63±1.06分,18.88±7.83 h和3.19±0.60 d,对照组分别是5.75±1.67分,41.63±7.13 h和5.38±1.13 d,两组差异有统计学意义(P<0.05)。术后观察组并发症发生率为16%(3例血清肿),对照组为28%(3例血清肿,2例切口脂肪液化,1例术后慢性疼痛和1例复发),两组差异无统计学意义(P>0.05)。结论正确掌握适应症,TAPP可以安全有效治疗急性腹股沟嵌顿疝,且具有创伤小、疼痛轻、恢复快等优点。

Objective To explore the clinical value of laparoscopic transabdominal preperitoneal herniorrhaphy in treatment of incarcerated inguinal hernia. Methods Clinical data of 44 patients with acute incarcerated inguinal hernia who underwent herniorrhaphy in our hospital from January 2015 to December 2016 were retrospectively analyzed. According to different operation methods, the patients were divided into observation group （n=19） and control group （n=25）. The observation group were received TAPP herniorrhaphy, and the control group were received open preperitoneal herniorrhaphy. The clinical curative effect of two groups were compared. Results Patients in two groups were fulfilled the operation successfully. The operation time and intraoperative blood loss of the observation group were 60.13±9.52 min and 6.00±2.27 mL, respectively. The control group were 60.25±10.71 min and 7.25±3.92 mL, respectively.The difference in 2 groups were not significant （P〉0.05）. The differences of postoperative VAS scores, postoperative intestinal recovery time and hospitalization time in observation group and control group were significant （2.63±1.06, 18.88±7.83 h, 3.19±0.60 d; 5.75±1.67, 41.63±7.13 h, 5.38±1.13 d; P〈0.05）. The incidence of postoperative complications in the observation group was 16%（3 cases of seroma） and the control group was 28% （3 cases of seroma, 2 cases of incision fat liquefaction, 1 case of chronic pain and 1 case of recurrence）. The difference was not significant （P〉0.05）. Conclusion With correct indication selection, TAPP will be safely and effectively applied on patients with acute incarcerated inguinal hernia. It has small trauma, less pain and quick recovery.