腹腔镜腹股沟疝修补术中直视下经皮穿刺置管引流积液预防术后血清肿的技巧与应用

The technique and application of percutaneous catheter drainage to prevent seroma in laparoscopic hernia repair for inguinal hernias

目的探讨在腹腔镜下经腹膜腔腹股沟疝修补术(TAPP)中直视下行经皮穿刺置管引流术,引流远端疝囊积气积液的操作技巧,以预防或干预治疗疝修补术后的血清肿。方法把2020年1月至2021年12月收治的85例腹股沟疝(坠入阴囊疝及巨大直疝)患者随机分为观察组及对照组,由同一术者行TAPP手术治疗,对照组行常规TAPP手术,观察组在行TAPP术中直视下,于腹壁经皮穿刺,将一直径12Ga一次性中心导管从腹膜外置入远端疝囊内,通过比较两组患者的手术指标、近期疗效指标及住院时间的差异,介绍腹腔镜疝修补术中直视下经皮穿刺置管的操作技巧、安全性、应用特点及优缺点。结果85例腹股沟疝患者全部手术成功,与对照组相比,观察组的近期血清肿发生率低、血清肿范围小、患者舒适度及满意度高,差异有统计学意义(均P<0.05),而两组的手术时间、住院时间、远期血清肿发生率等方面的差异无统计学意义(均P>0.05)。所有病例随访6个月至1年,均无复发,无发生术后感染。结论在TAPP中直视下经皮穿刺置管引流远端疝囊积气积液,穿刺操作安全、有效并微创,可有效预防术后血清肿的发生或减轻其的严重程度,减轻术后肿胀及患者的不适感,提高患者术后的舒适度及满意度,可广泛推广及应用。

Objective To evaluate the the technique of percutaneous catheter drainage to prevent seroma in laparoscopic hernia repair for inguinal hernias(TAPP).Methods A total of 85 patients with inguinal hernia(including incarcerated inguinal hernia and large direct hernia)who were admitted to our hospital from January 2020 to December 2021 were randomly divided into an observation group and a control group.Both groups underwent TAPP(transabdominal preperitoneal)surgery performed by the same surgeon.The control group received conventional TAPP surgery,while the observation group underwent direct visualization during TAPP surgery.A 12-gauge disposable central catheter was percutaneously punctured into the distant hernia sac through the abdominal wall.By comparing the surgical indicators,short-term efficacy indicators,and hospitalization time between the two groups,this study introduced the operative techniques,safety,application characteristics,and advantages and disadvantages of percutaneous catheter placement under direct visualization in laparoscopic hernia repair.Results All 85 patients with inguinal hernia underwent successful surgery.Compared with the control group,the observation group had a lower incidence and smaller range of postoperative seroma formation,higher patient comfort,and satisfaction,with statistically significant differences(all P<0.05).However,there were no statistically significant differences in surgical time,hospitalization time,and long-term seroma formation rate between the two groups(all P>0.05).All cases were followed up for 6 months to 1 year,and there were no recurrences or postoperative infections.Conclusion In laparoscopic transabdominal preperitoneal inguinal hernia repair(TAPP),percutaneous catheter placement under direct visualization for draining gas and fluid from the distant hernia sac is a safe,effective,and minimally invasive procedure.It can effectively prevent the occurrence of postoperative seroma or reduce its severity,alleviate postoperative swelling and patient discomfort,and improve patient comfort and satisfaction after surgery.This technique can be widely promoted and applied.