腹腔镜修补治疗耻骨上疝的经验

Experiences of laparoscopic repair for suprapubic hernia

目的:探讨腹腔镜修补治疗耻骨上疝的合理性、安全性和有效性。方法:回顾性分析2004年7月至2016年12月我科接受腹腔镜耻骨上疝修补术的90例病人临床资料,观察其临床疗效及并发症发生情况。结果:90例病人中89例完成腹腔镜耻骨上疝修补术,1例因严重粘连中转为开放Onlay修补。其中经腹腹膜前修补术(TAPP)7例,腹腔内补片修补术(IPOM)6例,经腹部分腹膜前修补术(TAPE)76例。疝缺损平均长径为(12.54±5.72)(2~30)cm,疝缺损平均面积为(92.98±62.09)(4~360)cm2。补片平均面积为(311.24±112.89)(80~600)cm2。平均手术时间为(54.04±16.60)(25~110)min。平均住院时间为(5.53±3.61)(1~33)d。术后使用镇痛药比例为8.99%(8/89)。术后复发4例,复发率为4.49%(4/89)。89例病人的中位随访时间为72(13~161)个月。结论:TAPP适用于治疗原发性耻骨上疝和腹膜较完整的小切口疝。TAPE是腹腔镜修补耻骨上疝的合理、安全且有效的术式。

Objective To evaluate the feasibility,safety and effectiveness of laparoscopic repair of suprapubic hernia.Methods The clinical data of 90 patients underwent laparoscopic repair of suprapubic hernia between July 2004 and December 2016 were analyzed retrospectively.The therapeutic effects and complications were reviewed.Results Totally 90 cases were in this study including 7 cases using transabdominal preperitoneal（TAPP）,6 cases traditional intraperitoneal onlay mesh（IPOM）,76 cases transabdominal partial extraperitoneal（TAPE） and 1 case converted to open Onlay repair due to severe adhesions.The defects were（12.54±5.72）（2-30） cm in max diameter and（92.98±62.09）（4-360） cm2 in size.The meshes applied were（311.24±112.89）（80-600） cm2 in size.The operation time was（54.04±16.60）（25-110） min and length of hospital stay was（5.53±3.61）（1-33） d.Eight cases used analgesics 8.99%（8/89） postoperatively and 4 cases were found recurrent 4.49%（4/89） during the follow-up of 72（13-161） months.Conclusions TAPP would be suitable for primary suprapubic hernias and small incisional hernias with intact peritoneum.TAPE is considered as a rational,safe and effective laparoscopic procedure for suprapubic hernia repair.