腹腔镜完全腹膜外疝修补术治疗老年腹股沟斜疝效果分析

目的分析腹腔镜完全腹膜外疝修补术(TEP)治疗老年腹股沟斜疝的效果。方法将64例老年腹股沟斜疝患者随机分为2组,每组32例。对照组实施开放无张力疝修补术(OTFH),腹腔镜组实施TEP。比较2组的疗效。结果 2组手术时间、术中出血量、术后并发症发生率及随访期间复发率比较,差异均无统计学意义(P0.05)。腹腔镜组术后24h和48 h的VAS评分低于对照组,术后住院时间短于对照组,住院费用高于对照组,差异有统计学意义(P0.05)。结论 OTFH与TEP治疗老年腹股沟斜疝均有可靠效果,OTFH术后患者疼痛程度轻、恢复时间短,但费用较高。应根据患者、术者及医院的条件合理选择。     

腹腔镜全腹膜外疝修补术339例报告

目的:探讨腹腔镜全腹膜外疝修补术(totally extraperitoneal prosthesis,TEP)的手术技巧与临床效果。方法:回顾分析2009年12月至2012年12月我院为339例患者行腹腔镜TEP的临床资料。结果:334例成功完成手术,2例中转开放手术,3例中转行经腹腹膜前疝修补术。手术时间平均(55±15.2)min,术中出血量平均(6.4±2.0)ml;术中腹膜撕裂19例。术后发生并发症11例,其中术后血清肿6例,阴囊气肿2例,修补区暂时性神经感觉异常2例,尿潴留1例;未发生慢性、持续性神经性疼痛、异物感、补片感染及切口感染。术后平均住院(3.0±0.6)d。术后随访3～24个月,平均(12.4±3.2)个月,2例复发。结论:TEP安全、复发率低、并发症少、痛苦轻、住院时间短、术后康复快,术者需熟练掌握腹股沟区解剖,合理选择手术方式,术中规范操作,以减少术中、术后并发症,提高手术疗效,防止复发。     

腹腔镜全腹膜外疝修补术331例临床分析

目的:探讨腹腔镜全腹膜外疝修补术(totally extraperitoneal,TEP)的手术技巧及术后并发症的防治。方法:回顾分析2012年5月至2014年6月为331例(428侧)患者行TEP的临床资料,总结手术疗效与操作技巧,以减少并发症的发生。结果:330例顺利完成TEP,1例中转为腹腔镜经腹腹膜前疝修补术。手术时间30~75 min,平均(40.3±4.6)min。术后6 h即可下床活动、进半流质饮食。术后1~3 d出院,术后平均住院(1.5±0.3)d。术中出现6例腹壁下血管损伤出血。术后随访1~24个月,无复发病例及切口感染、补片感染。术后血清肿68侧(15.9%),其中11例经穿刺抽液治愈。腹股沟区慢性疼痛(疼痛超过1个月)5例,术后3个月内疼痛均消失。结论:腹腔镜TEP可作为无全麻禁忌初发腹股沟疝患者的优先选择术式。     

腹腔镜全腹膜外疝修补术治疗嵌顿性腹股沟斜疝的临床效果

目的 探讨腹腔镜全腹膜外疝修补术(TEP)治疗嵌顿性腹股沟斜疝的临床效果.方法 回顾性分析2018-06—2020-06固始县人民医院普外科行手术治疗的68例嵌顿性腹股沟斜疝患者的临床资料.比较分别采用TEP和平片无张力修补术的2组患者的基线资料、围术期指标、术后并发症.结果 2组患者的基线资料差异无统计学意义(P>0...     

自制网塞应用于腹腔镜全腹膜外疝修补术方法探讨及临床研究

目的:探讨补片免钉合腹腔镜全腹膜外疝修补术(totally extraperitoneal,TEP)中应用自制网塞填塞腹壁缺损的临床价值及疗效。方法:回顾分析2011年1月至2015年10月收治的96例腹股沟疝患者的临床资料,其中50例行补片免钉合TEP加网塞充填疝修补术(研究组),46例行单纯补片免钉合TEP疝修补术(对照组),对比分析两组手术方法、治疗效果、手术指征等临床指标。结果:患者均顺利完成手术。两组手术时间、住院时间、耗材费用、阴囊血肿或血清肿及术后异物感差异无统计学意义(P0.05)。随访6~54个月,两组均无术后疼痛及复发病例。结论:网塞充填式TEP不仅适于腹壁缺损4 cm的腹股沟疝,更适于腹壁缺损4 cm的腹股斜疝与直疝,其临床应用前景及推广价值更高,是安全、实用、较理想的疝修补术式。     

腹腔镜腹股沟斜疝修补术

2005年4月—2006年7月笔者应用腹腔镜行疝内环口高位结扎和腹膜外置补片法对11例腹股沟斜疝实施腹腔镜疝修补术。结果示平均手术时间100~200 min。术中、术后无并发症，术后5~7d出院。随访6~15个月，无复发。提示腹腔镜腹股沟疝修补术具有安全、并发症少、恢复快、复发率低等优点，值得推广使用。     

单孔腹腔镜全腹膜外腹股沟疝修补术的效果探讨

目的:探讨单孔腹腔镜全腹膜外腹股沟疝修补术(totally extraperitoneal,TEP)的安全性及可行性,并总结其手术要点。方法:回顾分析2015年9月至2016年12月我院为25例腹股沟疝患者行单孔腹腔镜TEP的临床资料。结果:25例手术均获成功,无一例中转开放手术。手术时间67~123 min,平均(90.04±15.30)min;术后住院2~4 d,平均(3.16±0.75)d。2例患者术后发生阴囊血清肿,术后均无慢性疼痛、切口感染及补片排斥反应等其他术后并发症发生,切口愈合佳。术后随访3~24个月,无复发病例。结论:单孔腹腔镜TEP治疗腹股沟疝是安全、可行的,术后瘢痕小,美容效果好,可在熟练掌握常规腹腔镜TEP的基础上应用于对美观要求较高的患者。     

经皮内环补片单点固定法全腹膜外腹腔镜腹股沟 疝修补术临床应用研究

目的:探讨完全腹膜外腹腔镜腹股沟疝修补术(TEP)补片固定新方法——经皮内环补片单点固定法,评估其可行性、安全性、经济性。方法:前瞻性收集2017年3月至2018年3月行TEP的患者,符合入组标准的患者随机分为经皮内环补片单点固定法组(s-TEP)与补片免固定组(n-TEP),对比分析两组手术时间、术后住院时间、住院总费用及术后血清肿/血肿、感染、排尿困难、复发情况。结果:两组患者一般资料差异无统计学意义,手术均顺利完成,无一例中转手术。s-TEP组较n-TEP组手术时间短,差异有统计学意义;两组术后住院时间、总住院费用差异无统计学意义。s-TEP组发生血肿/血清肿5例,排尿困难2例;n-TEP组发生血肿/血清肿8例,感染1例,排尿困难2例,复发1例/1侧,两组并发症发生率、复发率差异无统计学意义。结论:采用经皮内环补片单点固定法,在不增加住院费用的同时明显缩短了手术时间,降低了手术难度,操作简单易行,具有良好的可行性、安全性、实用性。     

腹腔镜完全腹膜外疝修补术后再次手术原因探讨

目的:探讨腹腔镜完全腹膜外疝修补术后再次手术的原因。方法:总结2007年1月以来798例行腹腔镜完全腹膜外疝修补术患者的临床资料,回顾分析导致腹腔镜完全腹膜外疝修补术后二次手术的原因。结果:798例腹股沟疝患者于全麻下行腹腔镜完全腹膜外疝修补术,术后随访3~36个月,共27例患者因术后复发或手术并发症行二次手术,再手术率3.38%。其中12例术后复发,复发率1.50%;11例为腹股沟斜疝疝囊残端血肿或积液(1.38%);2例腹股沟斜疝于钉合处疼痛(0.25%);直疝术后疝外被盖突出与脂肪瘤各1例(0.13%)。27例患者再次手术后随访6~36个月,恢复良好。结论:腹股沟疝行腹腔镜完全腹膜外疝修补术后并发症(如巨大阴囊疝腔镜下结扎横断疝囊导致的残端血肿或积液)及术后疝复发是再次手术的主要原因。     

腹腔镜完全腹膜外疝修补术治疗腹股沟疝的疗效

目的总结腹腔镜完全腹膜外疝修补术（laparoscopic totally extra-peritoneal,TEP）治疗腹股沟疝患者临床体会。 方法回顾性分析2012年12月至2016年12月,中山市中医院采用TEP治疗成人腹股沟疝737例患者的临床资料,分析TEP术式对腹股沟疝患者的影响。 结果本组患者均顺利完成手术,其中12例嵌顿疝自内环口处行小切口回纳疝内容后再行TEP。手者行术时间（46±20）min,15例术后放置引流管,住院时间4～6 d,术后阴囊气肿3例,血清肿、阴囊血肿6例,随访11～59个月,复发2例。 结论TEP术是治疗腹股沟疝安全有效的术式,术后复发率低、恢复快,TEP是目前治疗腹股沟疝的重要术式。     

Single incision laparoscopic totally extraperitoneal inguinal hernia repair

Aims

Various single incision laparoscopic surgeries (SILS) and natural orifice transluminal endoscopic surgeries (NOTES) have been reported recently. Herein we performed SILS for totally extraperitoneal inguinal hernia repair (TEP) on three cases.

Cases

Three males of 72, 49, and 73?years old with the diagnoses of bilateral primary inguinal hernia underwent single incision TEP. The operative steps of single incision TEP are very similar to those of a traditional laparoscopic TEP. The difference between them is a 2?cm infraumbilical incision for the placement of three (5?mm) trocars in single incision TEP. We preferred to use a 30° 5?mm laparoscope with some routine laparoscopic instruments during the surgical procedure. All the hernia defects were repaired with VyproII of 15?×?10?cm (Ethicon, NJ, USA). The operations took 32, 26, and 65?min, respectively, with no obvious inconvenience.

Results

All three patients were discharged on the second postoperative day uneventfully. The postoperative follow-up showed no recurrence in the three patients up to now.

Conclusion

The single incision TEP using an access port device is safe and feasible. Meanwhile SILS may reduce medical costs and complication rates through practice and improvement of SILS instruments.     

腹腔镜全腹膜外疝修补术与Lichtenstein修补术的对比研究

目的:对比腹腔镜全腹膜外网片修补术与Lichtenstein修补术的临床疗效.方法:选择2008年3月至2009年12月86例腹股沟疝患者,随机分为两组,观察组行腹腔镜全腹膜外网片疝修补术,对照组行Lichtenstein无张力疝修补术.对比两组患者术后并发症、住院时间、下床时间等,术后随访7～27个月,对比两组的复发...     

单孔腹腔镜全腹膜外腹股沟疝修补术的学习曲线分析

目的探讨单一外科医师单孔腹腔镜腹股沟疝全腹膜外修补术（SILS -TEP）的学习曲线。 方法回顾性分析中山大学附属第五医院胃肠外科单一主刀医师和固定的助手于2017年8月至2018年9月期间采用自制单孔通道结合普通腹腔镜器械施行SILS -TEP的35例患者临床资料。 结果所有患者的手术都顺利进行,手术时间随手术例数增加而减少,手术出血量减少,15例以后手术时间基本稳定,随访6个月无复发。 结论有单孔腹腔镜手术经验的固定手术团队,达到熟练掌握SILS -TEP的学习曲线大约15例。     

Prospective audit of laparoscopic totally extraperitoneal inguinal hernia repair

BACKGROUND: This article reports the results of a multicenter prospective audit of totally extraperitoneal (TEP) inguinal hernia repair conducted by the Swiss Association for Laparoscopic and Thoracoscopic Surgery (SALTC) from May 1995 to August 1996. METHODS: At 29 Swiss centers 1,605 inguinal hernia repairs were performed in 1,186 patients. Half of the repairs were performed by operators whose experience consisted of fewer than 51 procedures. Patients were followed up for 1 year. RESULTS: Bilateral repairs were performed in 35% of the patients, and 15% of all repairs were for recurrent hernia. Conversion rates to the transabdominal preperitoneal (TAPP) technique and open surgery were 1.8% and 1.6%, respectively. Main postoperative complications were hematoma and urinary retention. At 3 months, seroma was more frequent with slit prosthesis. The recurrence rate was 0.6% at 3 months and 1.6% at 1 year, not depending on the type of implant. The rate for recurrent hernias did not differ from that for primary repairs. CONCLUSIONS: Total extraperitoneal (TEP) repair can be performed with low morbidity and a high level of patient satisfaction. The effects of the learning curve are not to be neglected. The 1-year recurrence rate is 1.6%. Published data on TEP suggest that late recurrences may be less frequent than after open repair.     

Simultaneous laparoscopic totally extraperitoneal repair for concurrent ipsilateral spigelian and indirect inguinal hernia

Simultaneous unilateral spigelian and inguinal hernia is uncommon. Majority of the approaches to repair of spigelian hernia is open surgery. We report our technique of a simultaneous repair of both spigelian and inguinal hernia using the totally extraperitoneal laparoscopic mesh repair.     

Unusual complications of laparoscopic totally extraperitoneal inguinal hernia repair

Although complications of laparoscopic totally extraperitoneal inguinal hernia repairs are well documented, the development of pneumothorax, pneumomediastinum and subcutaneous emphysema is rarely reported. The authors' experience with a 23-year-old man who developed intraoperative bilateral pneumothoraces and cervical subcutaneous emphysema during a laparoscopic totally extraperitoneal inguinal hernia repair prompted a MEDLINE literature review. Seven similar cases were found in which the patients developed pneumothorax, pneumomediastinum and/or subcutaneous emphysema following laparoscopic hernioplasty. An intercostal catheter was inserted in two out of the seven patients only. Numerous hypotheses were proposed for the development of these complications. Several authors felt that the duration of the procedure and preperitoneal insufflation pressures are related to the development of these complications. These potentially lethal complications must be diagnosed and managed promptly.     

腹腔镜下完全腹膜外与经腹腹膜前腹股沟疝修补术的临床疗效

目的对比腹腔镜下完全腹膜外与经腹腹膜前腹股沟疝修补术的临床疗效。 方法分层抽取深圳市光明新区人民医院普外科2014年1月至2016年1月,收治的腹腔镜下腹股沟疝修补术患者68例,采用随机数字表法将其分为观察组及对照组,每组34例患者。观察组采用完全腹膜外修补法（laparoscopic totally extraperitoneal,TEP）,对照组采用经腹腹膜前修补法（laparoscopic transabdominal preperitoneal hernia repair,TAPP）,术后对2组患者随访6～18个月,对比2组术中情况、住院时间,同时比较2组术后疼痛、并发症发生情况及复发情况。 结果观察组患者术后首次肛门排气时间、住院时间、术后疼痛时间均显著低于对照组（t=7.83、6.16、11.11,P均<0.05）;观察2组并发症发生率及腹股沟疝复发率均无明显差异（χ²=0.77、0.57,P=0.38、0.45）。 结论TEP较TAPP能进一步缩短术后疼痛时间及住院时间,但TEP对手术医师操作能力有较高要求,有待进一步培训推广。