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
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摘要
目的探讨女性腹股沟疝腹腔镜修补术(LIHR)中保留子宫圆韧带的临床安全性。方法回顾性分析2009年11月至2016年7月,中山大学附属第八医院收治的40例(45侧)行腹腔镜女性腹股沟疝修补术患者,依术中切断子宫圆韧带与否随机分成2组进行同期对照研究,随访时间3~36个月,平均(15±3)个月。结果 2组手术时间分别为(52±15)min和(31±6)min,差异有统计学意义(P<0.05);2组均无复发及补片感染病例,引流量分别为(35±8)ml和(53±11)ml。血肿、浆液肿发生率分别为10.5%和22.2%,腹股沟神经感觉异常或慢性疼痛发生率分别为5.3%和5.6%,差异无统计学意义(P>0.05)。大阴唇水肿的发生率分别是0和27.8%,差异有统计学意义(P<0.05)。结论 LIHR术中保留子宫圆韧带在技术上是可行的,仅延长手术时间,有利于降低大阴唇水肿,对降低子宫内膜异位症、慢性盆腔炎和不孕等长期远期并发症也可能起到一定作用,因此该术式值得推广。
Objective To explore the clinical safety of preservation the round ligament of the uterus in the laparoscopic repair of inguinal hernia( LIHR) in the females. Methods From November 2009 to July2016,37 cases of laparoscopic inguinal hernia repair in females were divided into two groups in accordance with the operation of the uterine round ligament cut off or not. The follow-up period were 3 to 36 months[mean of( 15 ± 3) months]. Results The operation time of the two groups were( 52 ± 15) minutes and( 31 ± 6) minutes,respectively. The difference was statistically significant( P < 0. 05). There were no recurrences and patch infections in the two groups. The drainage volume were( 35 ± 8) ml and( 53 ±11) ml; the incidence of hematoma/seroma were 10. 5% and 22. 2%; the incidence of inguinal nerve sensory abnormalities or pain were 5. 3% and 5. 6%,respectively. These differences were not statistically significant( P > 0. 05). The incidence of edema of the labia majora was 0 and 27. 8%,respectively,and the difference was statistically significant( P < 0. 05). Conclusion Thepreservation of the uterine ligament in LIHR is technically feasible,merelyprolongs the operation time,but it reduces the edema of the labia majora,and may help to reduce the endometriosis,chronic pelvic inflammatory disease and infertility.
Objective To explore the clinical safety of preservation the round ligament of the uterus in the laparoscopic repair of inguinal hernia( LIHR) in the females. Methods From November 2009 to July2016,37 cases of laparoscopic inguinal hernia repair in females were divided into two groups in accordance with the operation of the uterine round ligament cut off or not. The follow-up period were 3 to 36 months[mean of( 15 ± 3) months]. Results The operation time of the two groups were( 52 ± 15) minutes and( 31 ± 6) minutes,respectively. The difference was statistically significant( P < 0. 05). There were no recurrences and patch infections in the two groups. The drainage volume were( 35 ± 8) ml and( 53 ±11) ml; the incidence of hematoma/seroma were 10. 5% and 22. 2%; the incidence of inguinal nerve sensory abnormalities or pain were 5. 3% and 5. 6%,respectively. These differences were not statistically significant( P > 0. 05). The incidence of edema of the labia majora was 0 and 27. 8%,respectively,and the difference was statistically significant( P < 0. 05). Conclusion Thepreservation of the uterine ligament in LIHR is technically feasible,merelyprolongs the operation time,but it reduces the edema of the labia majora,and may help to reduce the endometriosis,chronic pelvic inflammatory disease and infertility.
引文
1龚志刚,饶敏,付敏,等.腹膜前间隙修补术在女性腹股沟疝治疗中的价值[J/CD].中华疝和腹壁外科杂志(电子版),2015,9(4):306-308.
2 Lundstrm 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.
3梁庆余,谢佳明,吴浩荣,等.腹腔镜修补成年女性腹股沟疝的临床研究[J/CD].中华腔镜外科杂志(电子版),2014,7(1):37-40.
4李健文,王文瑞.腹腔镜腹股沟疝修补术(TAPP)[J/CD].中华疝和腹壁外科杂志(电子版),2014,8(3):272.
5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.
6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.
7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.
8中华医学会外科学分会疝与腹壁外科学组.成人腹股沟疝、股疝和腹部手术切口疝手术治疗方案(2003年修订稿)[S].中华外科杂志,2004,42(14):834-835.
9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.
10刘嘉林,周汉新,余小舫,等.免气囊分离器完全腹膜外补片腹腔镜腹股沟疝修补术[J].中国现代手术学杂志,2004,8(5):282-285.
11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,2015,11(21):81-83.
12 Davis CJ,Arrequi ME.Laparoscopic repair for groin hernias[J].Surg Clin North Am,2003,83(5):1141-1161.
13 Chowbey PK,Sharma A,Khullar R,et al.Laparoscopic ventral hernia repair with extraperitoneal mesh:Surgical technique and early results[J].Surg Laparosc Endosc Percutan Tech,2003,13(2):101-105.
14刘嘉林,毕建钢,李晓军,等.腹腔镜全腹膜外修补股疝-附14例报告[J].岭南现代临床外科,2009,9(4):258-267.
15李健文,郑民华,李华清,等.腹腔镜全腹膜外补片植入术中补片固定与不固定的随机对照试验[J].中华普通外科杂志,2007,22(6):440-442.
16乐杰.妇产科学[M].5版.北京:人民卫生出版社,2002:10.
17李亮.实用腹股沟疝外科学[M].第一版.西安:世界图书出版西安有限公司,2014:10.
18 Lau H,Patil NG,Yuen WK,et al.Prevalence and severity ofchronic groin pain after endoscopic totally extraperitoneal inguinalhernioplasty[J].Surg Endosc,2003,17(10):1620-1623.
19汤建康,王维佳,张仕运,等.腹腔镜经腹腹膜前腹股沟疝修补术的术后疼痛分析[J].腹腔镜外科杂志,2015,12(23):66-68.
20王明刚,陈杰,申英末,等.腹腔镜腹股沟疝修补术中疝固定器与医用胶固定补片的疗效研究[J].北京医学,2010,7(17):42-44.
21管建松,戎桢祥,汤捷,等.自固定补片在完全腹膜外疝修补术中的应用前景及放置技巧[J/CD].中华疝和腹壁外科杂志(电子版),2015,4(1):7-10.
2 Lundstrm 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.
3梁庆余,谢佳明,吴浩荣,等.腹腔镜修补成年女性腹股沟疝的临床研究[J/CD].中华腔镜外科杂志(电子版),2014,7(1):37-40.
4李健文,王文瑞.腹腔镜腹股沟疝修补术(TAPP)[J/CD].中华疝和腹壁外科杂志(电子版),2014,8(3):272.
5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.
6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.
7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.
8中华医学会外科学分会疝与腹壁外科学组.成人腹股沟疝、股疝和腹部手术切口疝手术治疗方案(2003年修订稿)[S].中华外科杂志,2004,42(14):834-835.
9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.
10刘嘉林,周汉新,余小舫,等.免气囊分离器完全腹膜外补片腹腔镜腹股沟疝修补术[J].中国现代手术学杂志,2004,8(5):282-285.
11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,2015,11(21):81-83.
12 Davis CJ,Arrequi ME.Laparoscopic repair for groin hernias[J].Surg Clin North Am,2003,83(5):1141-1161.
13 Chowbey PK,Sharma A,Khullar R,et al.Laparoscopic ventral hernia repair with extraperitoneal mesh:Surgical technique and early results[J].Surg Laparosc Endosc Percutan Tech,2003,13(2):101-105.
14刘嘉林,毕建钢,李晓军,等.腹腔镜全腹膜外修补股疝-附14例报告[J].岭南现代临床外科,2009,9(4):258-267.
15李健文,郑民华,李华清,等.腹腔镜全腹膜外补片植入术中补片固定与不固定的随机对照试验[J].中华普通外科杂志,2007,22(6):440-442.
16乐杰.妇产科学[M].5版.北京:人民卫生出版社,2002:10.
17李亮.实用腹股沟疝外科学[M].第一版.西安:世界图书出版西安有限公司,2014:10.
18 Lau H,Patil NG,Yuen WK,et al.Prevalence and severity ofchronic groin pain after endoscopic totally extraperitoneal inguinalhernioplasty[J].Surg Endosc,2003,17(10):1620-1623.
19汤建康,王维佳,张仕运,等.腹腔镜经腹腹膜前腹股沟疝修补术的术后疼痛分析[J].腹腔镜外科杂志,2015,12(23):66-68.
20王明刚,陈杰,申英末,等.腹腔镜腹股沟疝修补术中疝固定器与医用胶固定补片的疗效研究[J].北京医学,2010,7(17):42-44.
21管建松,戎桢祥,汤捷,等.自固定补片在完全腹膜外疝修补术中的应用前景及放置技巧[J/CD].中华疝和腹壁外科杂志(电子版),2015,4(1):7-10.