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外科研究与新技术（中英文）

外科研究与新技术 ›› 2016, Vol. 5 ›› Issue (1): 23-25.

• 论著 • 上一篇    下一篇

解剖型补片在腹腔镜全腹膜外疝修补术中的应用

王以东,龚航军,韩刚,曹羽,张云   

  1. 上海中医药大学附属曙光医院
  • 收稿日期:2015-11-05 修回日期:2015-12-17 出版日期:2016-03-28 发布日期:2016-03-08
  • 通讯作者: 龚航军 E-mail:gonghangjun@citiz.net

Application of anatomical mesh in totally extraperitoneal hernia repair under the laparoscope

  • Received:2015-11-05 Revised:2015-12-17 Online:2016-03-28 Published:2016-03-08

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摘要： 目的 总结使用解剖型补片行腹腔镜全腹膜外疝修补术(totally extraperitoneal，TEP)治疗腹股沟疝的临床经验。方法 回顾分析2011年6月至2014年6月我院采用TEP术放置解剖型补片治疗腹股沟疝的临床资料。结果 本组54例患者手术均获成功，无中转其他术式，手术时间35～115min(平均单侧48 min，双侧105min) ，术中出血5～50 ml。其中术中腹膜破裂9例，造成气体进入腹腔，插入气腹针排气后均顺利完成手术；术后假性疝囊积液1例，穿刺后吸收；术后出现暂时性神经感觉异常1例，于术后1月恢复。住院时间3～6天,平均3.7天，随访1至4年，无腹股沟区慢性神经痛病例，无复发病例。结论 TEP术安全可靠，术后痛苦小、恢复快，已成为腔镜下治疗腹股沟疝的首选术式，我们选用的解剖型补片相对平面补片具有无需裁剪、操作简便、符合解剖结构、异物感小的优点，对于疝囊直径小于4cm的Ⅰ型、Ⅱ型腹股沟疝患者，补片无需固定，可以减少固定器材的使用，缺点是补片价格相对略高，但也为患者提供了一种更好的选择。

关键词: 腹腔镜, 腹股沟疝, 全腹膜外腹腔镜疝修补术, 解剖型补片

Abstract: Objective To summarize the clinical experience in using anatomical mesh for totally extraperitoneal (TEP) hernia repair under the laparoscope in the treatment of inguinal hernia. Methods The clinical data of patients receiving the placement of anatomical mesh for the treatment of inguinal hernia by TEP procedure in our hospital from June 2011 to June 2014 were retrospectively analyzed. Results The surgery was successful in all of the 54 cases in this group without switching to other surgical procedures, the operation duration was 35~115min (unilateral 48 min, bilateral 105min on average) and blood loss was 5~50ml. In these patients, 9 cases had intraoperative peritoneal rupture causing gas to enter the abdominal cavity, and the surgery was successfully completed after Veress needle was inserted for air discharge; 1 case had postoperative pseudo-sac effusion which was absorbed after puncture; 1 case experienced postoperative temporary nerve paresthesia which recovered 1 month after the surgery. The patients stayed in the hospital for 3~6 days, an average of 3.7 days, and were followed up for 1~4 years. There was no case of chronic neuropathic pain in the groin area and no recurrent case. Conclusion TEP procedure is safe and reliable with little postoperative pain and quick recovery, and has become the preferred surgical procedure for the treatment of inguinal hernia under the laparoscope. The anatomical mesh we selected features a number of advantages, including no necessity for cutting, simple operation, compliance with anatomical structure and little sense of foreign bodies compared with flat mesh. For patients with type I and II inguinal hernia whose hernial sac diameter is less than 4cm, the mesh does not need to be fixed, and thus can reduce the use of fixation device. The disadvantage is that the mesh is relatively expensive, but it does provide a better choice for patients.

Key words: Laparoscope, inguinal hernia, totally extraperitoneal hernia repair under the laparoscope, anatomic mesh