保留子宫圆韧带及补片完整的经腹腹膜前疝修补术的早期经验

Early experience of transabdominal preperitoneal hernia repair with preservation of round ligament of uterus and don't trim the mesh

目的分析保留子宫圆韧带及补片完整的经腹腹膜前疝修补术(TAPP)的可行性和有效性,解决女性腹股沟疝TAPP修补的子宫圆韧带是否保留的问题。方法回顾性分析2015年3月至2019年3月广东省中医院行TAPP术式的32例女性腹股沟疝患者的临床资料,根据术中使用裸化子宫圆韧带及T型切开腹膜两种手术方法分成裸化子宫圆韧带组(试验组)和T型切开腹膜组(对照组),术中技术要求需达到既保留子宫圆韧带同时不修剪补片。对比2组手术时间、术中出血量、术后疼痛发生率及术后复发率。结果试验组患者20例,对照组患者12例。试验组单侧手术时间(69.21±30.51)min,对照组(44.67±16.72)min,差异有统计学意义(P<0.05)。试验组和对照组术中出血量[(10.05±11.51)ml比(10.58±8.45)ml],平均住院时间[(4.05±2.33)d比(4.42±2.64)d]比较,差异均无统计学意义(P>0.05);2和3分患者占比和并发症发生率比较,差异均无统计学意义(P>0.05)。结论女性腹股沟疝行TAPP手术可保留子宫圆韧带,同时不必修剪补片,手术方法可行,手术效果良好。

Objective To analyze the feasibility and efficacy of transabdominal preperitoneal prosthesis(TAPP)with preservation of the round ligament of the uterus and mesh non Trialor,and to solve the problem of whether the round ligament of the uterus is preserved in TAPP repair of inguinal hernia in women.Methods The clinical data of 32 female patients with inguinal hernia who underwent TAPP from March 2015 to March 2019 in Guangdong Provincial Hospital of Traditional Chinese Medicine were retrospectively analyzed.According to the operation methods of bare round ligament of uterus and T incision peritoneum,the patients were divided into two groups:bare round ligament of uterus group(experimental group)and T incision peritoneum group(control group).The technical requirements of the operation should not only reserve the round ligament of the uterus but also not trim the mesh.The operation time,intraoperative blood loss,postoperative pain rate and postoperative recurrence rate were compared between the two groups.Results There were 20 patients in the test group and 12 patients in the control group.The time of unilateral operation in the experimental group(69.21±30.51)min and the control group(44.67±16.72)min were significantly different(P<0.05).There were no significant differences between the two groups in blood loss during operation[(10.05±11.51)ml vs(10.58±8.45)ml]and average hospital stay[(4.05±2.33)d vs(4.42±2.64)d;P>0.05].There was no significant difference between 2 and 3 points(P>0.05).Conclusion TAPP for inguinal hernia can preserve the round ligament of the uterus,also do not trim the mesh.It is feasible and effective.