腹腔镜全腹膜外腹股沟疝修补术联合腹腔镜胆囊切除术的临床疗效分析

Clinical effect evaluation of laparoscopic totally extraperitoneal inguinal hernia repair in combination with laparoscopic cholecystectomy

目的:评价腹腔镜完全腹膜外腹股沟疝修补术(TEP)联合腹腔镜胆囊切除术(LC)的安全性及有效性。方法:回顾分析2014年1月至2018年12月为19例患者行TEP联合LC的临床资料,患者均为单侧腹股沟疝,其中斜疝17例,直疝2例,手术由同一组医师完成,随访4~60个月,中位时间30个月。结果:手术均获成功,无一例中转开腹,手术时间48~89 min,平均(61.6±20.3)min;住院1~3 d,平均(2.1±1.0)d;住院费用19489.3~23514.5元,平均(21061.3±1867.4)元。无一例发生胆管损伤、胆漏。术后第1天疼痛视觉模拟评分1~4分,平均(3.16±2.27)分,无需止痛药物。术后无复发、补片感染发生,1例患者于术后第3天出现血清肿,保守治疗后消退。结论:TEP联合LC是安全、有效的,不会增加补片感染的风险及额外的创伤、疼痛,具有住院时间短、住院费用低等优点。

Objective:To evaluate the safety and efficiency of laparoscopic totally extraperitoneal(TEP)repair in combination with laparoscopic cholecystectomy(LC).Methods:The clinical data of 19 patients who underwent TEP in combination with LC between Jan.2014 and Dec.2018 were analyzed retrospectively.All the hernias were unilateral inguinal hernia,including 17 cases of indirect hernia and 2 cases of direct hernia.All the operations were performed by the same surgical team.The follow-up ranged from 4-60 months(median 30 months).Results:All operations were achieved and there was no conversion.The mean operation time was(61.6±20.3)min(48.0-89.0 min),the postoperative hospital stay was(2.1±1.0)d(1-3 d),and the hospitalization cost was(21061.3±1867.4)yuan(19489.3-23514.5 yuan).No biliary injury or bile leak occurred in this series.The pain visual analogue score of the first postoperative day was 3.16±2.27(range=1-4),and no analgesic was required.There were no recurrence or mesh infection occurred after operation,except that one case of seroma was found on the third postoperative day,which regressed after conservative therapy.Conclusions:TEP in combination with LC is safe and effective,has the advantages of reducing hospital stay and hospitalization cost with no increase of mesh infection and no additional trauma and pain to the patients.