腹腔镜全腹膜外疝修补术治疗腹股沟复发疝的临床分析(附47例报告)

Clinical analysis of laparoscopic totally extraperitoneal repair for treating recurrent inguinal hernia in 47 cases

目的:探讨腹腔镜全腹膜外疝修补术(totally extraperitoneal,TEP)治疗腹股沟复发疝的效果及手术技巧。方法:回顾分析2014年2月至2017年1月为47例腹股沟复发疝患者行TEP的临床资料。结果:47例手术均获成功,无一例中转开放,手术时间平均(62.7±13.4)min,出血量平均(8.6±3.2)ml,无副损伤发生。术后发生皮下气肿4例、血清肿5例、尿潴留1例,经过观察或治疗后患者均痊愈。术后随访,无再次复发、持续性疼痛、局部异物感、补片感染、切口感染发生。结论:TEP治疗复发疝安全、可行、有效,同时避免了腹腔镜经腹腹膜前疝修补术、腹腔内补片植入术的缺点。但TEP对术者的要求较高,需熟练掌握腹股沟区解剖、腹腔镜技术及复发疝的治疗要点,才能充分发挥TEP的优势,取得最佳疗效。

Objective： To summarize the surgical techniques and to explore the effect of laparoscopic totally extraperitoneal repair（ TEP） in the treatment of recurrent inguinal hernia. Methods： The clinical data of 47 patients who underwent laparoscopic TEP for the recurrent inguinal hernia from Feb. 2014 to Jan. 2017 were retrospectively analyzed. Results： All 47 operations were completed successfully and none was converted to open surgery. The operative time was（ 62. 7 ± 13. 4） min,the intraoperative blood loss was（ 8. 6 ±3. 2） ml. The complications occurred in 10 cases,including subcutaneous emphysema in 4 cases,seroma in 5 cases and acute urinary retention in 1 case,all these cases were cured by conservative therapies. No recurrence,persistent pain,foreign body sensation,mesh infection or incision infection were found during follow-up. Conclusions： TEP for the treatment of recurrent inguinal hernia is safe,feasible and effective and also avoids the shortcomings of laparoscopic transabdominal preperitoneal repair and intraperitoneal onlay mesh. However,the TEP operation has higher demands for the surgeon,who needs to have a good command of the technical points of inguinal anatomy,laparoscopic technique and the treatment of recurrent hernia so as to give full play to the advantages of TEP and achieve the best therapeutic effects.