摘要
目的:探讨腹腔镜完全腹膜外疝修补术(TEP)术中腹膜破裂的处理方式。方法:回顾分析2014~2019年220例TEP患者的临床资料,参照腹腔镜腹股沟疝手术操作指南施术,术中根据腹膜破裂口大小采用相应方法闭合腹膜。结果:218例顺利完成TEP,无中转开放病例。77例(35%)术中出现腹膜破裂,分离腹膜前间隙空间腹膜破裂15例,剥离疝囊时腹膜破裂60例,Trocar刺破2例;术中使用Hem-o-lok夹闭8例,自制圈套器套扎67例,2例(1%)改为腹腔镜经腹腹膜前腹股沟疝修补术。手术时间平均(60±12)min,术中出血量平均(5±2)mL,术后排气时间平均(20±2)h;术后平卧及沙袋压迫腹股沟区12 h,术后6 h进水进食,2 d下地活动,术后4~6 d痊愈出院;术中损伤腹壁下血管2例,术后切口感染1例。结论:腹膜破裂口按大小可分为1 cm内、1~5 cm、5~10 cm、10 cm以上,处理方式包括Hem-o-lok夹闭、套扎线套扎、腹膜外缝合、中转经腹腹膜前疝修补术进入腹腔缝合等。套扎线套扎的方式简单、实用,可操作性强,无术后并发症,值得推广。
Objective:To explore the treatment of peritoneal laceration in the laparoscopic totally extraperitoneal(TEP)hernia repair.Methods:The clinical data of 220 patients with TEP from 2014 to 2019 were retrospectively analyzed.Surgical procedures referred to the guidelines of laparoscopic herniorrhaphy for inguinal hernia.The peritoneal laceration was sutured by different ways according to the size.Results:TEP was successful in 218 patients without conversion to open surgery.77 patients(35%)had intraoperative peritoneal laceration.Peritoneal laceration occurred for reconstruction of preperitoneal space in 15 patients,separation of hernial sac in 60 patients and Trocar puncture in 2 patients.The peritoneum was clipped by using Hem-o-lok in 8 patients and self-made snare ligation in 67 patients.2 patients were converted to laparoscopic transabdominal preperitoneal repair.The operative time was(60±12)min,intraoperative blood loss was(5±2)mL,the postoperative exhaust time was(20±2)h.The patients were in horizontal position and sandbag was used to press the groin area 12 h after surgery,patients began to drink water and take food after 6 h,got out of bed after 2 d,recovered and were discharged in 4-6 d after operation.Inferior epigastric vessels in 2 cases were injured in operation and 1 case had postoperative incision infection after surgery.Conclusions:The size of the peritoneal laceration could be subdivided into less than 1 cm,1 cm to 5 cm,5 cm to 10 cm and greater than 10 cm.Management includes Hem-o-lok clipping,ligation thread ligation,extraperitoneal suture,conversion to transabdominal preperitoneal repair for intraperitoneal suture.Ligation thread ligation is simple,practical and feasible without postoperative complications and it is worth spreading.
作者
莫健文
苏惠贞
董烈斌
宋雪芬
周沛华
伍炎俊
余健雄
司徒升
MO Jian-wen;SU Hui-zhen;DONG Lie-bin(Department of General Surgery,Kaiping Central Hospital,Kaiping 529300,China)
出处
《腹腔镜外科杂志》
2020年第5期383-385,共3页
Journal of Laparoscopic Surgery
关键词
疝
腹股沟
完全腹膜外疝修补术
腹腔镜检查
腹膜破裂
Hernia,inguinal
Totally extraperitoneal hernia repair
Laparoscopy
Peritoneal laceration
