摘要
目的探讨经腹探查改良腹腔镜全腹膜外腹股沟疝修补术式(total extraperitoneal repair,TEP)的可行性和优越性。方法从2003年10月至2004年6月,完成了传统TEP术60例。从2004年7月至2007年8月对160例腹股沟疝患者实施了经腹探查改良TEP(即手术开始先行经腹探查)。按术中是否经腹探查分为传统TEP组和改良TEP组。登记患者年龄、性别,记录术中发现对侧隐匿性腹外疝例次、术中漏气与否(是否需要Verres针排放腹腔气体)、术后住院天数、术后恢复日常活动天数以及术后复发情况。结果改良TEP组160例诊断出40例隐匿性腹外疝,包括32例腹股沟疝,8例股疝,而传统TEP组60例中仅发现4例隐匿性腹股沟疝。两组对隐匿性腹外疝的检出比例分别为25%和6.67%,经检验χ2=9.167,P<0.05;比较两组漏气入腹的发生比例19.4%和16.7%,检验χ2=0.127,P>0.05,比较两组患者术后住院天数、恢复日常活动天数,经t检验,P值均>0.05;改良TEP组回纳经体外不能回纳的大网膜14例,联合行腹腔镜胆囊切除术4例,腹腔镜阑尾切除术3例,与泌尿外科合作同期切除同侧隐睾5例,精索鞘膜积液切除和前列腺电切各1例。传统TEP组有2例复发,腹股沟斜疝和直疝各1例,均位于对侧。结论经腹探查加传统TEP术式是可行的,改良TEP提高了传统TEP术式的效果,扩展了TEP的手术适应症,使TEP联合其它常见腹部外科腹腔镜手术得以实现。
Objective To evaluate and analysis whether transabdominal inspection benefits total extraperitoneal repair （TEP） or not for inguinal hernia. Methods Traditional TEP have been introduced in sixty patients with inguinal hernia from October 2003 to June 2004, and modified TEP with transabdominal in- spection in the initial stage had been introduced in one hundred and sixty patients. The patients were divided into traditional and modified TEP groups. The general data, the occult contralateral hernias, leakage of CO2 into peritoneal cavity during operating（ the procedure of entering Verres needle to release CO2 ） ,the duration stay in hospital postoperatively and to resume routine activity, and the recurrence of TEP were collected. Re- sults Forty occult hernias were found in 160 cases （25%）of modified TEP group, but only four found in 60 cases （6.67%）of traditional TEP group. The difference in two groups was significant. The incidence of leakage of C02into peritoneal cavity during operation, the duration stay in hospital postoperatively and to re- sume routine activity in two group were compared, no significant differences were found. Two recurrent ingui- nal hernias in contralateral side were found in traditional TEP group. Reduction of omentum 14 cases, com- bination with laparoscopic cholecystectomy 4 cases, appendectomy 3 cases, resection of eryptorchidism 5 ea- ses, and resection of funicular hydrocele and transurethral resection of prostate 1 case respectively , were completed in modified TEP group. Conclusions Modified TEP with transabdominal inspection, enlarge the indication of TEP and accomplish the combination of other laparoseopie procedure easily.
出处
《中华疝和腹壁外科杂志（电子版）》
2009年第2期18-21,共4页
Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition)
关键词
疝
腹股沟
腹腔镜
全腹膜外疝修补术
经腹探查
Hernia,inguinal
Laparoseopic
Total extraperitoneal repair
Transabdominal inspection
