Keyhole法保留子宫圆韧带在育龄女性患者中的应用体会
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摘要
目的:探讨育龄女性腹股沟疝患者行腹腔镜下经腹腹膜前疝修补术(transabdominal preperitoneal,TAPP)中子宫圆韧带的理想处理方法。方法:回顾分析2015年1月至2017年10月为15例育龄女性腹股沟疝患者行TAPP的临床资料,术中均采用keyhole法保留子宫圆韧带。结果:15例手术均顺利完成,手术时间平均(56.67±10.98)min,术后平均住院(2.4±1.3)d;术后随访3~32个月,均无复发、慢性疼痛、术区血清肿及大阴唇水肿;3例已成功受孕。结论:TAPP术中采用Keyhole法保留子宫圆韧带,尽管手术时间延长,但符合人体正常解剖结构,最大限度地保留了子宫圆韧带的生理功能,术后并发症少,复发率低,对生育无影响,对于育龄女性腹股沟疝患者更值得推荐。
Objective: To investigate the ideal treatment method of the round ligament of uterus in the laparoscopic transabdominal preperitoneal repair( TAPP) for inguinal hernia in the female of childbearing age. Methods: The clinical data of 15 females with inguinal hernia in childbearing age from Jan.2015 to Oct.2017 were retrospectively analyzed.All patients received TAPP,and they were treated with keyhole method to preserve the round ligament of uterus.Results: All 15 operations were successfully completed.The average operation time was( 56.67±10.98) min,and the average postoperative hospitalization time was( 2.4±1.3) d.All patients were followed up for 3-32 months.There was no recurrence,chronic pain,seroma and labia majora edema.3 patients successfully conceived after operation.Conclusions: It is a good method to preserve the round ligament of uterus by keyhole method during TAPP.Although the operation time is prolonged,it is in line with the normal anatomical structure of the human body.The physiological function of the round ligament of uterus is preserved to the maximum with few postoperative complications,low recurrence rate and no effect on the fertility.It is worthier of recommendation for the inguinal hernia in the female of childbearing age.
Objective: To investigate the ideal treatment method of the round ligament of uterus in the laparoscopic transabdominal preperitoneal repair( TAPP) for inguinal hernia in the female of childbearing age. Methods: The clinical data of 15 females with inguinal hernia in childbearing age from Jan.2015 to Oct.2017 were retrospectively analyzed.All patients received TAPP,and they were treated with keyhole method to preserve the round ligament of uterus.Results: All 15 operations were successfully completed.The average operation time was( 56.67±10.98) min,and the average postoperative hospitalization time was( 2.4±1.3) d.All patients were followed up for 3-32 months.There was no recurrence,chronic pain,seroma and labia majora edema.3 patients successfully conceived after operation.Conclusions: It is a good method to preserve the round ligament of uterus by keyhole method during TAPP.Although the operation time is prolonged,it is in line with the normal anatomical structure of the human body.The physiological function of the round ligament of uterus is preserved to the maximum with few postoperative complications,low recurrence rate and no effect on the fertility.It is worthier of recommendation for the inguinal hernia in the female of childbearing age.
引文
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[12]张冬辉,张剑宝,庄哲宏,等.成年女性腹腔镜腹股沟疝修补术中保留与切断子宫圆韧带的随机对照研究[J/CD].中华疝和腹壁外科杂志(电子版),2017,11(2):115-118.
[13]唐健雄,郑民华,陈杰,等.腹腔镜腹股沟疝手术操作指南(2017版)[S/CD].中华疝和腹壁外科杂志(电子版),2017,11(6):401-406.
[14]张光永,展翰翔,刘少壮,等.腹腔镜下经腹腔腹膜前疝修补术中子宫圆韧带的处理体会[J].腹腔镜外科杂志,2013,18(10):721-724.
[15]罗靖,古少东,庞天龙,等.腹腔镜下经腹腔腹膜前疝修补术中子宫圆韧带的处理[J].中国内镜杂志,2015,21(5):548-550.
[16]刘昶,杨凯,纪艳超,等.腹腔镜经腹腹膜前修补股疝并子宫圆韧带重建8例疗效分析[J].中国实用外科杂志,2015,35(2):195-197.
[17]王庆涛,伍颖君,黄海洋.女性腔镜下腹股沟疝手术的临床研究[J].微创医学,2015,10(3):320-322.
[18]马东扬,宋应寒,谢妍妍,等.子宫圆韧带切断固定术[J/CD].中华疝和腹壁外科杂志(电子版),2016,10(3):229.
[19]王骥,王文瑞,李健文,等.腹腔镜手术治疗女性腹股沟疝225例临床分析[J].中国实用外科杂志,2015,35(11):1220-1222.
[2]Memon MA,Cooper NJ,Memon B,et al.Meta-analysis of randomized clinical trials comparing open and laparoscopic inguinal hernia repair[J].Br J Surg,2003,90(12):1479-1492.
[3]Horisberger K,Jung MK,Zingg U,et al.Influence of type of mesh fixation in endoscopic totally extraperitoneal hernia repair(TEP)on long-term quality of life[J].World J Surg,2013,37(6):1249-1257.
[4]Lundstrom KJ,Sandblom G,Smedberg S,et al.Risk factors for complications in groin hernia surgery:a national register study[J].Ann Surg,2012,255(4):784-788.
[5]李健文,王明刚,唐健雄,等.腹股沟疝腹腔镜手术规范化操作指南[J].中国实用外科杂志,2013,35(7):566-570.
[6]Ozdegirmenci O,Karslioglu Y,Dede S,et al.Smooth muscle fraction of the round ligament in women with pelvic organ prolapse:a computer-based morphometric analysis[J].Int Urogynecol J Pelvic Floor Dysfunct,2005,16(1):39-43.
[7]丁晓曼,冷金花,郎景和.芳香酶与子宫内膜异位症关系的研究[J].现代妇产科进展,2001,10(4):299-301.
[8]Giudice LC,Kao LC.Endometriosis[J].Lancet,2004,364(9447):1789-1799.
[9]葛春晓,刘梦梅,丁慧娟,等.腹腔镜在不孕症盆腔疾病诊治中的应用(附340例分析)[J].中华生殖与避孕杂志,1994,14(1):65-69.
[10]陆桂玲,朱慧清,廖金兰.腹腔镜子宫悬吊术治疗不孕症的临床研究[J].腹腔镜外科杂志,2005,10(4):235-236.
[11]孙惠军.女性腹股沟斜疝的圆韧带与疝囊关系分型和处理[J/CD].中华疝和腹壁外科杂志(电子版),2014,8(4):377.
[12]张冬辉,张剑宝,庄哲宏,等.成年女性腹腔镜腹股沟疝修补术中保留与切断子宫圆韧带的随机对照研究[J/CD].中华疝和腹壁外科杂志(电子版),2017,11(2):115-118.
[13]唐健雄,郑民华,陈杰,等.腹腔镜腹股沟疝手术操作指南(2017版)[S/CD].中华疝和腹壁外科杂志(电子版),2017,11(6):401-406.
[14]张光永,展翰翔,刘少壮,等.腹腔镜下经腹腔腹膜前疝修补术中子宫圆韧带的处理体会[J].腹腔镜外科杂志,2013,18(10):721-724.
[15]罗靖,古少东,庞天龙,等.腹腔镜下经腹腔腹膜前疝修补术中子宫圆韧带的处理[J].中国内镜杂志,2015,21(5):548-550.
[16]刘昶,杨凯,纪艳超,等.腹腔镜经腹腹膜前修补股疝并子宫圆韧带重建8例疗效分析[J].中国实用外科杂志,2015,35(2):195-197.
[17]王庆涛,伍颖君,黄海洋.女性腔镜下腹股沟疝手术的临床研究[J].微创医学,2015,10(3):320-322.
[18]马东扬,宋应寒,谢妍妍,等.子宫圆韧带切断固定术[J/CD].中华疝和腹壁外科杂志(电子版),2016,10(3):229.
[19]王骥,王文瑞,李健文,等.腹腔镜手术治疗女性腹股沟疝225例临床分析[J].中国实用外科杂志,2015,35(11):1220-1222.