腹腔镜腹股沟疝修补术的初期应用体会

目的:探讨初期开展腹腔镜腹股沟疝修补术的注意事项,术中、术后常见并发症及其处理措施。方法:回顾分析2012年10月至2013年5月为21例患者行腹腔镜腹股沟疝修补术的临床资料,其中19例行全腹膜外疝修补术(totally extraperitoneal,TEP),2例行经腹腹膜前疝修补术(transabdominal preperitoneal,TAPP)。结果:1例TEP患者中转行TAPP。手术时间TEP平均(92±41.38)min,TAPP平均(122±26.38)min,术中腹壁下血管损伤1例,腹膜撕裂5例,均无血清肿、内脏损伤、尿潴留及输精管损伤,未见切口及深部创面感染,术后未使用止痛剂。患者均于术后第1天恢复正常饮食并下床活动。患者术后第1、3、6个月获得电话随访,无腹股沟区慢性疼痛及复发。结论:熟悉、掌握腹腔镜下腹膜前间隙及其重要结构、选择合适的手术方式是避免腹腔镜腹股沟疝修补术中、术后并发症发生的关键。

Initial experiences of laparoscopic inguinal hernia repair

Objective：To explore the announcements of laparoscopic inguinal hernia repair at initial stage and methods of sol- ving common intraoperative and postoperative complications. Methods：The clinical data of 21 patients who were performed laparoscopic transabdominal preperitoneal （TAPP） or totally extraperitoneal （TEP） operation from Oct. 2012 to May 2013 were retrospectively ana- lyzed. TEP was performed in 19 cases, TAPP hernia repair was performed in 2 cases. Results：One case of TEP was converted to TAPP. The operation time was （92 -＋ 41.38 ） rain for TEP and （ 122 ＋_ 26.38 ） rain for TAPP. 1 case of the inferior epigastric vessels injury and 5 cases of peritoneum tearing occurred, seroma, visceral injury, urinary retention, deferent duct injuries and wound infections were not been observed. No analgesic was used after the procedures. Patients all returned to normal diet and out-of-bed activity in the first day af- ter operation. There was no chronic pain in inguinal region or recurrence of hernia at 1,3,6-month follow-up by telephone. Conclu- sions ： Acquainting and mastering laparoscopic preperitoneal space and its important structure and selecting suitable modus operandi are the keys to avoid intraoperative and postoperative complications of laparoseopic inguinal hernia repair.