中国实用外科杂志

中国实用外科杂志

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腹腔镜全腹膜外修补术治疗腹股沟疝1437例操作体会

陆景锋1，李华青2，李健文1，郑民华1，王文任1，王    骥1，丁军彬2，刘维燕2   

  1. 1上海交通大学医学院附属瑞金医院普外科，上海 200025；2复旦大学附属闵行医院普外科，上海 201100
  • 出版日期:2015-08-01 发布日期:2015-07-27

  • Online:2015-08-01 Published:2015-07-27

摘要：

目的    总结腹股沟疝腹腔镜全腹膜外修补术（TEP）的手术操作体会及临床疗效。方法    回顾性分析2001年1月至2012年12月上海交通大学医学院附属瑞金医院普外科收治的1437例行TEP病人（1783侧疝）的临床资料。随访10～60个月（中位时间47个月）。结果    手术时间为（30.0±12.0）min，单侧（26.2±9.6）min，双侧（42.5±10.7）min。无病人术后须应用镇痛剂，术后第1天疼痛分数为（2.4±1.2）分。术后住院时间为（1.5±1.2）d。2周和4周内恢复非限制性活动病人比例为99.2%和99.9%。共7例（0.4%）复发，复发时间1 d至84个月（中位时间36个月）。仅发生1例严重并发症，为肠管损伤，其他并发症为血清肿76例（4.3%）、尿潴留22例（1.2%)、暂时性神经感觉异常9例（0.5%）、麻痹性肠梗阻1例（0.06%）。结论    TEP是一种安全有效的手术，病人疼痛轻、恢复快，术后复发率低，在合理选择适应证的前提下，适宜临床广泛推广应用。

关键词: 腹股沟疝, 腹腔镜, 全腹膜外修补术

Abstract:

Operation experience of totally laparoscopic extraperitoneal inguinal hernia repair：A report of 1437 patients             LU Jing-feng*，LI Hua-qing，LI Jian-wen，et al. *Department of General Surgery，Rui Jin Hospital，Shanghai Jiao Tong University School of Medicine，Shanghai 200025，China
Corresponding author：LI Jian-wen，E-mail：ljw5@yeah.net
Abstract    Objective    To summarize the operation experience and clinical effect of totally laparoscopic extraperitoneal inguinal hernia repair (TEP). Methods    The clinical data of 1437 patients (1783 hernias) underwent TEP between Jan. 2001 and Dec. 2012 in Department of General Surgery，Rui Jin Hospital，Shanghai Jiao Tong University School of Medicine were analyzed retrospectively. The follow-up period ranged from 10 to 60 months (median 47 months). Results The mean operation time was 30.0±12.0 minutes with 26.2±9.6 minutes for unilateral hernia and 42.5±10.7 minutes for bilateral hernia. No analgetic was required. The VAS pain grade in the first day after the surgery was 2.4±1.2. The length of postoperative hospital stay was 1.5±1.2 days. Patients returned to usual activities in 2 weeks and 4 weeks accounted for 99.2%和99.9% respectively. The overall recurrence rate was 0.4%（7/1783）. The recurrent time ranged from 1 day to 84 months (median 36 months). There were 1 severe complications: bowel injury. Other complications included 76 seroma (4.3%)，22 urinary retention (1.2%)，9 transient neurapraxia (0.5%) and 1 paralytic ileus (0.06%). Conclusion    TEP is a safe and efficient technique，with less pain，faster postoperative recovery and lower recurrence rate. On the premise of reasonable selection of indications，TEP is suitable for clinical application widely.

Key words: inguinal hernia, laparoscopy, totally extraperitoneal prosthesis（TEP）