腹腔镜下经腹腹膜前修补术治疗耻骨上切口疝的临床观察

Clinical observation of laparoscopic transabdominal preperitoneal repair for suprapubic hernia

目的:探讨改良经腹腹膜前补片置入技术在腹腔镜耻骨上切口疝修补术中的应用效果及安全性、可靠性。方法:回顾分析2015年1月至2019年1月收治的36例耻骨上切口疝患者的临床资料,其中1例合并右侧腹股沟疝。结果:36例均完成腹腔镜下耻骨上切口疝修补术,35例经腹腹膜前补片置入术修补耻骨上切口疝,游离腹膜前间隙至耻骨弓下方2 cm,全层关闭腹壁缺损,放置补片,连续缝合关闭腹膜;1例加行腹腔镜右侧腹股沟疝无张力修补术。1例患者因游离腹膜瓣破损无法覆盖补片,改行部分腹膜前补片修补术,无一例中转开腹。腹壁缺损3.0~11.0 cm,平均(8.5±1.0)cm;手术时间60~130 min,平均(90±15)min。术区血清肿3例,1个月后自行吸收;术后慢性疼痛2例,未特殊处理2周后逐渐缓解;无肠梗阻、补片排异反应等其他并发症发生。术后随访9~45个月,无一例复发。结论:经腹腹膜前补片置入技术应用于腹腔镜耻骨上切口疝修补术中安全、可靠,可降低医疗成本,值得推广。

Objective:To explore the effect,safety and reliability of an improved transperitoneal anterior patch placement technique in laparoscopic suprapubic incision hernia repair.Methods:The clinical data of 36 patients with suprapubic incisional hernia who underwent laparoscopic transabdominal preperitoneal repair from Jan.2015 to Jan.2019 were retrospectively analyzed.In the 36 patients,one had concurrent right inguinal hernia.Results:Laparoscopic suprapubic incisional hernia repair was successfully performed in all patients.35 cases were repaired by transabdominal preperitoneal patch placement:the preperitoneal space was dissociated to about 2 cm below the inferior edge of the pubic arch,the hernia defect was closed with a full-thickness transabdominal suture,then the mesh was placed to cover the defect and the peritoneal flap was closed with continuous suture.One case was added with laparoscopic tension-free repair of right inguinal hernia.One case was converted to laparoscopic partial preperitoneal repair because the damaged peritoneal flap could not completely cover the mesh.There was no conversion to laparotomy in these patients.The diameter of the hernia ring was 3.0-11.0 cm with the average of(8.5±1.0)cm.The operating time ranged from 60 to 130 min with the average of(90±15)min.There were 3 cases with operative area seroma,which was absorbed without treatment after 1 month.There were 2 cases with postoperative chronic pain,which was relieved without special treatment within two weeks.There were no complications such as intestinal obstruction or rejection of patch.No recurrence was observed in the follow-up of 9-45 months.Conclusions:The technique of transperitoneal preperitoneal patch placement is safe and reliable in laparoscopic suprapubic hernia repair,which can reduce the cost of medical treatment and is worth popularizing.