腹腔镜经腹腹膜前疝修补术中斜疝疝囊横断术与剥离术对其术后并发症的影响

Comparison of postoperative complication between sac transection and complete sac reduction for indirect hernia during laparoscopic trans-abdominal preperitoneal hernia repair

目的比较腹腔镜腹股沟疝修补术中斜疝疝囊横断与完全剥离对手术并发症的影响。方法回顾性分析2016年1月至2020年6月于江苏省人民医院溧阳分院行腹腔镜经腹腹膜前疝修补术(TAPP)166例男性单侧腹股沟斜疝的病例资料。根据手术方式,分为疝囊横断组(86例)与完整剥离组(80例)。比较2组患者的术后疼痛、复发及血清肿等指标。结果2组之间的术后急性、慢性疼痛差异无统计学意义(P>0.05)。疝囊离断组术后2 d和7 d的血清肿发生率(18.6%和27.8%)高于疝囊完整剥离组(7.5%和15.0%),差异有统计学意义(P<0.05)。术后3个月,血清肿自行消失。术后随访6~36个月所有患者均未复发。结论TAPP术中,疝囊完整剥离与疝囊横断术疗效相当,医师可根据患者的术中情况选择横断或者剥离。尽管疝囊横断术后血清肿会增加,但是在3个月内会自愈。

Objective To compare the postoperative complications of sac transection and complete sac reduction for indirect hernia during laparoscopic trans-abdominal preperitoneal repair(TAPP).Methods The data of 166 male unilateral indirect hernia patients who underwent TAPP procedure in Liyang Branch of Jiangsu Provincial People's Hospital from January 2016 to June 2020 were retrospectively analyzed.The patients were classified into two groups according to surgical methods:the transected sac group(86 cases)and the completely reduced sac group(80 cases).The postoperative pain,hernia recurrence and seroma formation were compared between two groups.Results There was no significant difference in the acute postoperative pain and chronic pain between the two groups(P>0.05).The incidence of seroma at 2 and 7 days after the operation in the sac transection group(18.6%and 27.8%)was higher than that in the complete sac reduction group(7.5%and 15.0%),and the difference was statistically significant(P<0.05).The seroma disappeared spontaneously 3 months after the operation.All patients were followed up for 6 to 36 months without recurrence.Conclusion Complete sac reduction during TAPP has the same efficacy as sac transection.Surgeons can choose transection or reduction according to the patient's intraoperative situation.Although transection of the hernia sac during TAPP repair may cause seromas,it will heal spontaneously within 3 months.