负压引流在腹腔镜经腹腹膜前疝修补术后减少血清肿的临床应用

Application of negative pressure drainage for reducing seroma after Transabdominal Preperitoneal

目的探讨腹腔镜经腹腹膜前疝修补术(transabdominal preperitoneal,TAPP)中放置负压引流管在减少术后血清肿发生的临床应用价值。方法将2016年2月至2017年2月,上海中医药大学附属普陀医院连续收治的68例成人单侧Ⅱ、Ⅲ型腹股沟斜疝患者随机分为2组,均接受TAPP术。其中引流组38例,在关腹膜前将十字形负压引流管放置于疝补片与腹膜之间,引流管从同侧戳卡孔引出接负压吸球。对照组30例,未放置负压引流。将2组患者的手术时间、术后住院时间、术后血清肿发生率进行比较。结果 68例患者均顺利出院,引流组平均手术时间较对照组长[(52.50±12.06)min比(48.83±15.23)min],但差异无统计学意义(P>0.05)。引流组术后平均住院时间较对照组长[(3.29±0.98)d比(1.93±0.69)d],差异有统计学意义(P<0.05)。引流组血清肿发生率明显低于对照组[2.6%(1/38)比26.7%(8/30)],差异有统计学意义(P<0.05)。结论负压引流可观察术后积液或出血情况,降低血清肿发生;负压管还可有效减少死腔,防止补片移动。十字形负压引流无侧孔洞,引流效果佳,不易堵塞,拔除便捷,不易使补片移位。

Objective To evaluate the efficacy of negative pressure drainage for reducing seroma after transabdominal preperitoneal（TAPP）. Methods From Feb.2016 to Feb.2017, 68 consecutive adult patients with unilateral indirect inguinal hernia in Putuo Hospital Affiliated to Shanghai University of TCM were randomly divided into two groups and underwent TAPP.38 cases in the drainage group had a cross-type negative pressure drainage tube placed between the mesh and peritoneum before suturing peritoneum, while 30 cases in the control group without any drainage tube. The operative time, hospital stays and the incidence rate of seroma between the two groups were compared. Results All 68 patients had smooth recovery. Compared with the control group, the drainage group had a longer average operative time（52.50±12.6 min vs. 48.83±15.23 min; P〉0.05）, but this result was not statistically significant, and also had a longer hospital stays after operation（3.29±0.98 day vs. 1.93±0.69 day; P〈0.05）, the result was statistically significant. Incidence of seroma in drainage group was obviously lower than that in the control group（1/38, 2.6% vs. 8/30, 26.7%; P〈0.05）, the result was significantly different. Conclusion Negative pressure drainage is helpful to observe fluid collection and bleeding after surgery, and to reduce the incidence of seroma. In addition, the negative pressure drainage tube can reduce dead space and prevent the migration of the mesh. The cross-type negative pressure drainage tube has no side holes with better drainage effect and is not easy to be blocked. The removal of drainage tube is convenient, and not easy to cause mesh migration.