中国实用外科杂志

中国实用外科杂志 ›› 2025, Vol. 45 ›› Issue (05): 553-558.DOI: 10.19538/j.cjps.issn1005-2208.2025.05.14

• 论著 • 上一篇    下一篇

应用个体化补片行腹腔镜手术治疗腹膜前植入补片复发疝可行性分析

王晨星，薛    佩，李健文，乐    飞，冯    波，宋海勤，程    兮，付占威   

  1. 上海交通大学医学院附属瑞金医院普外科，上海 200025
  • 出版日期:2025-05-01 发布日期:2025-05-28

  • Online:2025-05-01 Published:2025-05-28

摘要： 目的    分析腹膜前植入补片的复发疝行腹腔镜手术治疗，采用个体化补片的安全性和有效性。方法    回顾性分析2011年1月至2024年12月间上海交通大学医学院附属瑞金医院普外科接受腹腔镜腹股沟疝修补术（LIHR）的478例（515侧）复发疝病人的临床资料。按前次手术类型分组，比较高位结扎术（45例）、单纯缝合修补术（203例）、李金斯坦修补术（89例）、平片网塞修补术（81例）和腹膜前修补术（包括开放腹膜前修补术和LIHR，60例）病人临床资料和手术疗效；腹膜前有补片植入的复发疝141例病人按阶段分组，前阶段为2011年1月至2017年12月（80例），后阶段为2018年1月至2024月12月（61例），比较前后两阶段采用个体化补片技术病人的临床资料和手术疗效。结果    除高位结扎术外，单纯缝合、李金斯坦、平片网塞、腹膜前等各组修补术后复发疝，病人基线资料比较差异无统计学意义（P>0.05）。腹膜前植入补片（包括平片网塞修补术和腹膜前修补术）的复发疝与腹膜前无补片组（高位结扎术、单纯缝合修补术、李金斯坦修补术）相比，直疝复发比例高、手术时间较长、术后住院天数较长，差异有统计学意义（P<0.05）。对腹膜前植入补片的复发疝进行分层分析，前后两阶段病人基线资料比较差异无统计学意义（P>0.05），后阶段经腹腹膜前修补术（TAPP）成功率（94.0% vs. 91.1%，P=0.016）、手术时间［（50±12） min vs.  （47±15）min，P=0.045］、术后住院天数［（2.0±1.0） d vs. （1.7±1.5） d，P<0.001）］等指标均优于前阶段，差异有统计学意义。结论    LIHR治疗腹膜前植入补片的复发疝有一定的难度，采用个体化补片的局部修补技术安全有效，是可行的方法。

关键词: 复发性腹股沟疝, 腹膜前, 腹腔镜, 个体化补片, 治疗 

Abstract: To analyze the safety and effectiveness of applying tailored mesh in laparoscopic repair of recurrent hernia with preperitoneal mesh. Methods    A retrospective analysis was performed based on the clinical data of 478 patients (515 hernias) with recurrent hernia who underwent laparoscopic inguinal hernia repair (LIHR) at Shanghai Ruijin Hospital between January 2011 and December 2024. Patients were grouped according to the type of previous surgery, with comparisons of clinical data and surgical outcomes among the following groups: high ligation (n=45), simple suture repair (n=203), Lichtenstein repair (n=89), mesh plug repair (n=81), and preperitoneal repair (including open preperitoneal repair and LIHR, n=60). Additionally, a total of 141 patients with recurrent hernia who had preperitoneal mesh were grouped by stage. The previous stage was from January 2011 to December 2017 (80 cases), and the later stage was from January 2018 to December 2024 (61 cases). Clinical data and surgical efficacy were compared across two stages to assess the clinical outcomes and efficacy of the tailored mesh technique. Results    Except for high ligation repair, no significant differences were observed in the baseline data among groups after simple suture, Lichtenstein, mesh plug, preperitoneal (including open preperitoneal or LIHR) repair (P>0.05). Compared with the no preperitoneal mesh group (including high ligation, simple suture and Lichtenstein repair), the recurrent hernia with preperitoneal mesh implanted (including mesh plug and preperitoneal repair) had a higher incidence of direct hernia recurrence, longer operation time, and longer postoperative hospital stay, with statistically significant differences (P<0.05). A stratified analysis of recurrent hernias with preperitoneal mesh showed no significant differences in baseline data between the two stages (P>0.05). However, the TAPP success rate (94.0% vs. 91.1%, P=0.016), operation time ［(50±12) min vs.  (47±15)min, P=0.045］, and postoperative hospital stay ［(2.0±1.0) d vs. (1.7±1.5) d, P<0.001)］ in the later stage were all better than those in the previous stage, with statistically significant differences. Conclusion    LIHR for recurrent hernias with preperitoneal mesh presents certain technical challenges. However, local repair technology with tailored mesh is safe, effective, and feasible. 

Key words: recurrent inguinal hernia, preperitoneal, laparoscopy, tailored mesh, treatment