腹腔镜经腹腹膜前修补术治疗巨大阴囊疝的安全性及可行性分析

Analysis of the safety and feasibility of transabdominal preperitoneal approach in the treatment of huge inguinoscrotal hernia

目的总结腹腔镜经腹腹膜前疝修补术(TAPP)治疗巨大阴囊疝的经验,探讨其安全性和可行性。方法回顾性分析2015年1月—2018年3月上海交通大学医学院附属瑞金医院普外科连续开展的26例病例。均为男性,年龄(68.3±14.1)岁,年龄范围57~86岁。体重指数(23.3±4.1)kg/m2。Bathel指数91.4±5.6。术中主要步骤按《腹股沟疝腹腔镜手术规范化操作指南》操作。术中常规不放置引流管及尿管,术后无不适出院。观察各病例的中转情况、术中并发症、手术时间、术中失血量及术后住院时间。术后经电话及门诊随访,随访期12个月以上并观察远期并发症及Bathel指数变化值等数据。使用配对样本t检验比较手术前后Bathel指数变化情况。结果无术中中转及术中、术后严重并发症发生病例,术后手术部位血清肿17例(65.4%)。所有病例手术时间(76.5±23.6)min,术中失血量(8.6±4.4)mL,术后住院时间(2.3±1.2)d。术后1月Bathel指数96.9±3.2,与术前比较差异有统计学意义(t=-6.968,P=0.000)。结论TAPP治疗巨大阴囊疝安全可行,熟悉其解剖特点并掌握相应操作要点是手术成功的重要因素。

Objective To summarize the experience of laparoscopic transabdominal preperitoneal hernia repair(TAPP)and to discuss its safety and feasibility.Methods Data of 26 consecutive cases from January 2015 to March 2018 in Ruijin Hospital,Shanghai Jiao Tong University School of Medicine were analyzed retrospectively.They were all males,aged(68.3±14.1)years,with a range from 57 to 86 years.Body mass index was(23.3±4.1)kg/m2.Bathel indexwas 91.4±5.6.Intraoperative main procedures were done in accordance to Guideline of Standardized Operation for Laparoscopic Inguinal Hernia Repair.A drainage tube or catheter was not routinely placed intraoperatively.Patients were discharged but for any complaints.Observation data included intraoperative,postoperative and following-up data.The following-up period was more than 12 months by telephone or clinic.The long-term complications and the changes of Barthel index were observed.Paired sample t test was used to compare the changes of Barthel index before and after operation.Results Of the 26 cases,none was converted to open procedure and no intra-or post-operative serious complications occurred.Occurrence of surgical site seroma was 17(65.4%)cases.The operating time was(76.5±23.6)min.Intraoperative blood loss was(8.6±4.4)mL.The postoperative hospitalization was(2.3±1.2)d.Bathel index in 1 month postoperative was 96.9±3.2.It was higher statistically than that preoperative(t=-6.968,P=0.000).Conclusions TAPP in the treatment of huge inguinoscrotal hernia is safe and feasible.Mastering the anatomical characteristics and the according procedures is an important factor for successful operation.