摘要
目的:探讨腹腔镜全腹膜外(totally extraperitoneal,TEP)腹股沟疝无张力修补术术中固定平补片的实用性及要点。方法:2012年1月至2016年11月收治102例患者,腹股沟斜疝、直疝及股疝共108侧。TEP术中建立10 mm观察孔、2个(或3个)5 mm Trocar操作孔,将平片修剪为近椭圆形11 cm×15 cm,作为主作用平片;修剪1.2 cm×4~8 cm小片条,作为辅助固定平片。小片条后腰带式方法呈"V"形固定同侧输精管、精索或子宫圆韧带。结果:99例采用两孔法完成手术,3例采用三孔法,无一例中转开放手术。Ⅲ型疝中6例巨大腹股沟疝(外环口大于3指),术中于外环口水平做2 cm横切口,直视下间断缝闭数针,以缩小外环口。术中4例患者出血超过50 ml;2例患者于肌耻骨孔区放置引流管;无肠管、膀胱损伤及大片皮下气肿(面积>15 cm×15 cm)发生。术后第1天可下床活动,3~7 d出院,平均(3.6±1.2)d。术后4例患者发生7 cm×6 cm×5 cm以上阴囊肿,经抬高阴囊、卧床休息后15~35 d自愈。未发生与本次疝手术相关的再手术,1例患者术后一年出现对侧新发疝。结论:TEP术中利用人体自有韧性组织固定主平片,位移小;经修剪的小片条后腰带式固定主平片,固定方法简单实用、效果可靠,覆盖疝内环口理想,具有一定的临床应用价值。
Objective：To discuss the practicability and key points of fixing flat patch during laparoscopic totally extraperitoneal（TEP） tension-free herniorrhaphy.Methods：One hundred and two patients with 108 sides of direct inguinal hernia,indirect inguinal hernia and femoral hernia were enrolled from Jan.2012 to Nov.2016.During the operations,a 10 mm observing port and two or three5 mm Trocars as operation ports were created.The flat plug was trimmed into the shape of a 11 cm × 15 cm near oval as the main flat patch.A 1.2 cm × 4-8 cm small piece was trimmed for accessorial fixation of the flat patch.The small piece was fixed in a＂V＂shape with vas deferens,spermatic cord or round ligament of the uterus.Results：Ninety-nine cases were performed with two-port technique,three cases were performed with three-port technique,without conversion to laparotomy.2 cm transverse incision and interrupted sutures were performed at the external inguinal ring to narrow the ring on six giant inguinal hernia of type Ⅲ hernia with the external inguinal ring bigger than three fingers.During the operation,4 patients lost more than 50 ml blood,2 patients were placed with drainage tubes at myopectineal orifice region,none suffered from injury of bowel or bladder or large subcutaneous emphysema（larger than 15 cm ×15 cm）.Patients could get off bed one day after surgery.The hospital stay was（3.6 ± 1.2） d in average（range 3 to 7 d）.4 patients suffered from scrotal swelling（larger than 7 cm × 6 cm × 5 cm） and cured by lifting and resting after 15-35 d.No patients received any related reoperation,one diagnosed with new onset contralateral hernia.Conclusions：It is simple,effective and ideal to fix the main flat plug in laparoscopic totally extraperitoneal herniorrhaphy by using patients＇ connatural tissues with the post belt-like fixation technique.
出处
《腹腔镜外科杂志》
2017年第6期448-451,共4页
Journal of Laparoscopic Surgery
关键词
疝
腹股沟
全腹膜外
疝修补术
腹腔镜检查
平片固定
Hernia
inguinal
Totally extraperitoneal
Herniorrhaphy
Laparoscopy
Patch fixation
