改良腹膜切口在腹腔镜经腹膜前腹股沟疝修补术中的应用

Application of improved peritoneal incision in laparoscopic transabdominal preperitoneal inguinal hernia repair

目的探讨腹腔镜经腹膜前腹股沟疝修补术(TAPP)沿精索平行切口改良腹膜切口的应用价值。方法回顾分析2014年2月至2017年12月在我院施行改良腹膜切口TAPP的62例临床资料。结果 62例手术均获得成功,无中转手术病例。手术时间为(51.16±11.23)min。62例患者中,单纯斜疝51例,直疝7例,直疝合并斜疝2例,股疝2例。其中复发疝3例,难复性或嵌顿性疝5例。其中双侧疝16例(术前诊断双侧疝5例,术中发现隐匿性疝11例)。术后发生阴囊水肿5例,无阴囊血肿。术后下床活动时间(8.27±3.65)h,住院时间为(5.25±2.67)d。术后1、6个月随访未见腹股沟区慢性疼痛、复发、肠黏连等并发症。结论改良腹膜切口在腹腔镜经腹膜前腹股沟疝修补术中分离疝囊、缝合腹膜方面更简便,特别是在处理复发疝、难复或嵌顿性疝、女性疝方面有优势。

Objective To explore the application value of improved peritoneal incision in laparoscopic TAPP. MethodsThe clinic data of 62 patients who performed improved peritoneal incision in laparoscopic TAPP in our hospital fromFebruary 2014 to December 2017 were retrospective analysed. Results Operations were successful in all 62 cases, noconversion to open hernia repair. The time of operation was （51.16+-11.23） min. There were simple oblique in 51 cases,direct hernia in7 cases, direct hernia combined with oblique hernia in2 cases, femoral hernia in2 cases. There were3cases of recurrent hernia,5 cases of refractory or incarcerated hernia. There were 16 cases of bilateral hernia,5 cases ofwhich found by preoperative diagnosis, and 11 cases of occult hernia were found in operation. There were postoperativescrotal edema in 5 cases patients, there was no scrotal hematoma. The postoperative ambulation time was （8.27+-3.65） h,hospitalization time was （5.25+-2.67） d. There were no postoperative complications such as chronic pain in inguinal region,recrudescence or intestinal adhesion in 1, 6 months＇ follow -up. Conclusion Improved peritoneal incision is easier toseparate hernia sac, and suture peritoneum in laparoscopic TAPP, especially in the treatment of recurrent hernia,irreducible hernia, incarcerated henia and female hernia.