中国实用外科杂志

中国实用外科杂志

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应用腹腔镜经腹腔腹膜前疝修补术治疗腹股沟复发疝临床价值探讨

曹金鑫，王明刚，朱熠林，杨    硕，刘雨辰，申英末   

  1. 首都医科大学附属北京朝阳医院疝和腹壁外科，北京100043
  • 出版日期:2017-11-01 发布日期:2017-11-01

  • Online:2017-11-01 Published:2017-11-01

摘要：

目的    探讨腹腔镜经腹腔腹膜前疝修补术（TAPP）在治疗腹股沟复发疝方面的临床价值。方法    回顾性分析2010年6月至2016年6月期间首都医科大学附属北京朝阳医院疝和腹壁外科应用腹腔镜TAPP治疗的腹股沟复发疝354例病人资料。结果    354例顺利完成腹腔镜TAPP。手术时间30～90 min，平均（54.7±19.4）min；住院时间2～14 d，平均（4.7±2.1）d；术后随访12～60 个月，平均（37.7±12.4）个月。术中组织损伤发生率4.5%（16/354），术后并发症发生率13.6%（48/354），均经治疗痊愈，未发生局部严重异物感、切口感染、肠梗阻等并发症。无术后感染及慢性疼痛发生。2例（0.6%）复发病人，均经再次手术后恢复良好，随访未再复发。 结论    在具备一定腹腔镜疝手术经验的前提下，腹腔镜TAPP是前入路术后复发疝的首选治疗方式；是“后入路”术后复发疝的一种可以选择的手术治疗方式，但尚缺乏足够的循证医学依据支持。

关键词: 腹腔镜, 腹股沟疝, 复发, 疝修补术

Abstract:

Clinical value of using laparoscopic transabdominal preperitoneal technique in recurrent inguinal hernia repairment        CAO Jin-xin,WANG Ming-gang,ZHU Yi-lin,et al. Department of Hernia and Abdominal Wall Surgery，Beijing Chao-Yang Hospital，Capital Medical University，Beijing 100043，China
Corresponding author:WANG Ming-gang,E-mail：wmgonly@126.com
Abstract    Objective    To discuss the clinical value of laparoscopic transabdominal preperitoneal (TAPP) technique in recurrent inguinal hernia repairment.　Methods    The clinical data of 354 cases of recurrent inguinal hernia who were accepted the TAPP surgery from June 2010 to June 2016 in Department of Hernia and Abdominal Wall Surgery，Beijing Chao-Yang Hospital of Capital Medical University were analyzed retrospectively.　Results    All the 354 cases accept completed laparoscopic operations successfully．The operation time was 30-90 min ,with the average time  (54.7±19.4)min; the length of stay was 2-14 d and the average time was (4.7±2.1)d．The follow-up time was 12-60 months and the average time was (37.7±12.4)months.The rate of intraoperative injury was 4.5%(16/354) and the rate of postoperative complications were 13.6%(48/354)．There was no complication such as foreign body sensation，wound infection and intestinal obstruction． There was no mesh infection and long-term chronic pain.Two cases (0.6%) recurred, and recovered after the operation again, and no more recurrence was found. Conclusion    With the surgeon's rich experience and excellent technique, TAPP technique is the preferred treatment for recurrent hernia after “anterior approach”,and an alternative treatment for recurrent hernia after “posterior approach” with lack of adequate evidence-based support.

Key words: laparoscope, inguinal hernia, recurrence, hernia repair