同侧复发性腹股沟疝腹腔镜腹膜前修补术93例分析
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摘要
目的探讨腹腔镜腹膜前修补术治疗同侧复发性腹股沟疝的可行性。方法我院2012年12月～2017年12月我科对93例复发性腹股沟疝(单侧90例,双侧3例;复发性斜疝51例,复发性直疝42例)行全腹膜外(total extraperitoneal,TEP)或经腹腹膜前(transabdominal preperitoneal,TAPP)腹腔镜修补术,Bogros间隙或髂窝间隙内粘连分离较困难时,使用防粘连涂层补片经腹部分腹膜外补片植入术(transabdominal partial extraperitoneal,TAPE)或经腹腹腔内补片植入术(intraperitoneal onlay mesh,IPOM)。结果 93例手术均顺利,无中转开放手术。TEP 63例,手术时间25～60 min,平均37. 4min,术中出血量5～20 ml,平均9. 6 ml。TAPP 30例,1例改行TAPE,1例改行IPOM,30例手术时间35～90 min,平均49. 1min,术中出血量5～30 ml,平均15. 6 ml。93例术后住院时间1～3 d,平均1. 3 d。5例术后出现腹股沟区或阴囊局部血肿或血清肿,多次穿刺抽吸后均好转。93例术后随访6～60个月,无切口感染、腹股沟区顽固性疼痛及疝再复发等。结论腹腔镜腹膜前修补术是治疗复发性腹股沟疝安全可行的方式。选择合适的病例和术式,注意术中的操作要点是再手术成功的关键。
Objective To summarize the feasibility of laparoscopic preperitoneal hernioplasty for treating ipsilateral recurrent inguinal hernia. Methods A retrospective analysis was made on 93 patients undergoing laparoscopic preperitoneal hernioplasty for recurrent inguinal hernia from December 2012 to December 2017. Among them there were 51 cases of recurrent indirect hernia and 42 cases of direct hernia. There were 90 cases of unilateral hernia and 3 cases of bilateral hernia. Total extraperitoneal( TEP) or transabdominal preperitoneal( TAPP) laparoscopic hernioplasty was performed. When the separation of adhesion in Bogros space or iliac fossa space was difficult,the transabdominal partial extraperitoneal( TAPE) or intraperitoneal onlay mesh( IPOM) hernioplasty was performed intraoperatively. Results All the 93 cases of laparoscopic hernioplasty were carried out uneventfully without conversion to open operation. The number of TEP was 63. The operative time was 25-60 min( mean,37. 4 min). the intraoperative blood loss was 5-20 ml( mean,9. 6 ml). The number of TAPP was 30. Among them one case was converted to transabdominal partial extraperitoneal hernioplasty and one was converted to intraperitoneal onlay mesh hernioplasty. The operative time was 35-90 min( mean,49. 1 min). The intraoperative blood loss was 5-30 ml( mean,15. 6 ml). The length of postoperative hospitalization of all the 93 cases was 1-3 d( mean,1. 3 d). Five cases had local hematoma or seroma in the inguinal region or scrotum after operation,and all of them improved after repeated puncture and aspiration. Follow-ups for 6-60 months in the 93 cases showed no surgical site infection,inguinal intractable pain or hernia recurrence. Conclusion Laparoscopic preperitoneal hernioplasty in the treatment of recurrent inguinal hernia is safe and feasible. The key to success of this operation is to make an appropriate selection of cases and operation type and to master the intraoperative manipulation.
Objective To summarize the feasibility of laparoscopic preperitoneal hernioplasty for treating ipsilateral recurrent inguinal hernia. Methods A retrospective analysis was made on 93 patients undergoing laparoscopic preperitoneal hernioplasty for recurrent inguinal hernia from December 2012 to December 2017. Among them there were 51 cases of recurrent indirect hernia and 42 cases of direct hernia. There were 90 cases of unilateral hernia and 3 cases of bilateral hernia. Total extraperitoneal( TEP) or transabdominal preperitoneal( TAPP) laparoscopic hernioplasty was performed. When the separation of adhesion in Bogros space or iliac fossa space was difficult,the transabdominal partial extraperitoneal( TAPE) or intraperitoneal onlay mesh( IPOM) hernioplasty was performed intraoperatively. Results All the 93 cases of laparoscopic hernioplasty were carried out uneventfully without conversion to open operation. The number of TEP was 63. The operative time was 25-60 min( mean,37. 4 min). the intraoperative blood loss was 5-20 ml( mean,9. 6 ml). The number of TAPP was 30. Among them one case was converted to transabdominal partial extraperitoneal hernioplasty and one was converted to intraperitoneal onlay mesh hernioplasty. The operative time was 35-90 min( mean,49. 1 min). The intraoperative blood loss was 5-30 ml( mean,15. 6 ml). The length of postoperative hospitalization of all the 93 cases was 1-3 d( mean,1. 3 d). Five cases had local hematoma or seroma in the inguinal region or scrotum after operation,and all of them improved after repeated puncture and aspiration. Follow-ups for 6-60 months in the 93 cases showed no surgical site infection,inguinal intractable pain or hernia recurrence. Conclusion Laparoscopic preperitoneal hernioplasty in the treatment of recurrent inguinal hernia is safe and feasible. The key to success of this operation is to make an appropriate selection of cases and operation type and to master the intraoperative manipulation.
引文
1 Miserez M,Peeters E,Aufenacker T,et al.Update with level 1studies of the European Hernia Society guidelines on the treatment of inguinal hernia in adult patients.Hernia,2014,18(2):152-163.
2中华医学会外科学分会腹腔镜与内镜外科学组,中华医学会外科学分会疝与腹壁外科学组,大中华腔镜疝外科学院.腹股沟疝腹腔镜手术规范化操作指南.中国实用外科杂志,2013,33(7):566-570.
3汤治平,苏远航,陈双.主动腹膜切开在完全腹膜外疝修补术中的应用.中华疝与腹壁外科杂志(电子版),2013,7(3):210-211.
4 Primatesta P,Goldacre MJ.Inguinal hernia repair:incidence of elective and emergency surgery,readmission and mortality.Int JEpedemiol,1996,25(4):835-839.
5 Beets GL,Oosterhuis KJ,Go PM,et al.Long term follow up(12-15 years)of a randomized controlled trial comparing Bassini-Stetten,Shouldice and high ligation with narrowing of the internal ring for primary inguinal hernia repair.J Am Coll Surg,1977,185(4):352-357.
6 Feng B,He ZR,Li JW,et al.Feasibility of incremental laparoscopic inguinal hernia repair development in China:an 11-year experience.J Am Coll Surg,2013,216(2):258-265.
7李健文,陈鑫.从指南的角度谈腹腔镜疝手术的应用规范.临床外科杂志,2013,21(6):422-424.
8鲁旭,吴立胜,刘玉海,等.经腹腹膜前腹腔镜疝修补术治疗腹股沟复发疝.中国微创外科杂志,2014,14(4):331-333.
2中华医学会外科学分会腹腔镜与内镜外科学组,中华医学会外科学分会疝与腹壁外科学组,大中华腔镜疝外科学院.腹股沟疝腹腔镜手术规范化操作指南.中国实用外科杂志,2013,33(7):566-570.
3汤治平,苏远航,陈双.主动腹膜切开在完全腹膜外疝修补术中的应用.中华疝与腹壁外科杂志(电子版),2013,7(3):210-211.
4 Primatesta P,Goldacre MJ.Inguinal hernia repair:incidence of elective and emergency surgery,readmission and mortality.Int JEpedemiol,1996,25(4):835-839.
5 Beets GL,Oosterhuis KJ,Go PM,et al.Long term follow up(12-15 years)of a randomized controlled trial comparing Bassini-Stetten,Shouldice and high ligation with narrowing of the internal ring for primary inguinal hernia repair.J Am Coll Surg,1977,185(4):352-357.
6 Feng B,He ZR,Li JW,et al.Feasibility of incremental laparoscopic inguinal hernia repair development in China:an 11-year experience.J Am Coll Surg,2013,216(2):258-265.
7李健文,陈鑫.从指南的角度谈腹腔镜疝手术的应用规范.临床外科杂志,2013,21(6):422-424.
8鲁旭,吴立胜,刘玉海,等.经腹腹膜前腹腔镜疝修补术治疗腹股沟复发疝.中国微创外科杂志,2014,14(4):331-333.