经内环补片单点固定法全腹膜外腹腔镜腹股沟疝修补术临床应用研究

Clinical analysis of totally extra-peritoneal laparoscopic inguinal hernia repair with single point patch-fixation through inner ring

目的探索经内环补片单点固定法在全腹膜外腹腔镜腹股沟疝修补术(totally extraperitoneal,TEP)中可行性及适用性。方法回顾性分析2013年1月至2016年12月115例行经内环补片单点固定法全腹膜外腹腔镜腹股沟疝修补术(TEP)病人临床资料,统计该组病人手术时间、术后使用镇痛药例数、胃肠功能恢复时间、术后下床活动时间、住院时间及术后并发症等指标。结果除1例病人中转开放手术外其余均顺利完成手术,平均手术时间为48 min(36～70 min),术中出血0～20 ml,术后排气时间为(12.3±4.0)h,下床活动时间为(18.0±3.8)h,平均住院时间2.8 d。术后12例出现并发症(10.6%),其中慢性疼痛2例(1.7%)、阴囊积液3例(2.6%)、术后尿潴留4例(3.4%)、皮下血肿1例(0.8%)、局部异物感2例(1.7%),随访12～55个月,无复发。结论经内环补片单点固定法全腹膜外腹腔镜腹股沟疝修补术安全可行,操作简单,经济实用,适合临床应用。

Objective To explore the feasibility and applicability of totally extra-peritoneal laparoscopic（TEP）inguinal hernia repair with single point patch-fixation through inner ring.Methods A retrospective analysis was conducted over January 2013 to December 2016 on115 patients who accepted the TEP inguinal hernia repair with single point patch-fixation through inner ring.The operational time,postoperative pain,gastrointestinal function recovery time,the bedside movement time,and the incidence of postoperative complications were noted.Results All the patients were performed successfully except one patient converted to open operation The mean operational time was 48 min（36-70 min）,the gastrointestinal function recovery time was（12.3±4.0）h,the bedside movement time was（18.0±3.8）h,and the hospital stay was 2.8 days.The postoperative complications occurred in12 cases with an incidence of 10.6%.Of all,chronic groin pain occurred in 2 cases,and the incidence was1.7%;scrotal hydrocele was found in 3 case,and the incidence was 2.6%;the postoperative urinary retention was observed in 4 cases,and the incidence was 3.4%;subcutaneous haematoma was observed in 1 case with the incidence was 0.8%;foreign body sensation in groin area can be identified in2 cases,and the incidence was 1.7%.The patients were followed up for 12 to 55 months,and no recurrence occurred.Conclusions The method of TEP laparoscopic inguinal hernia repair with single point patch-fixation through inner ring is safe and feasible,simple,as well as being economical and practical.It is well worth of clinical application.