摘要
目的分析腹腔镜腹股沟疝修补术后复发因素及二次手术治疗效果。方法回顾性分析2017年1月至2021年12月首都医科大学附属北京朝阳医院疝和腹壁外科收治的41例腹腔镜腹股沟疝修补术后复发病例的资料,均为男性,年龄(62±7)岁(范围:51~75岁),复发时间为术后3 d至7年,分析患者的手术方式、复发原因、手术治疗结果等情况。率的比较采用Fisher确切概率法。结果全部病例中经腹腹膜前疝修补术(TAPP)后复发31例,全腹膜外疝修补术后复发10例。采用TAPP治疗11例,Lichtenstein手术治疗30例。复发因素可分为4类,包括补片覆盖范围不足23例,补片卷曲9例,补片挛缩7例,补片固定不当2例。再次手术治疗后随访[M(IQR)]18(24)个月(范围:12~50个月),患者无再次复发、感染、慢性疼痛、异物感等。TAPP和Lichtenstein手术的术后血清肿发生率差异无统计学意义[3/11比20.0%(6/30),P=0.68]。结论腹腔镜腹股沟疝术后复发多存在补片覆盖范围不足,再次行TAPP或Lichtenstein手术能够达到良好的治疗效果。
Objective To analyze the recurrence factors and reoperation effect of laparoscopic inguinal hernia repair.Methods A total of 41 patients with recurrence after laparoscopic repair of the inguinal hernia admitted to the Department of Hernia and Abdominal Wall Surgery,Beijing Chaoyang Hospital Affiliated to Capital Medical University from January 2017 to December 2021 were retrospectively analyzed.All patients were males,aging(62±7)years(range:51 to 75 years).The recurrence intervals were 3 days to 7 years postoperatively.The surgical methods,causes of recurrence,and treatment outcomes of the patients were analyzed.Fisher exact probability method is used to compare the rates.Results Among all cases,the primary surgical procedures included transabdominal preperitoneal herniorrhaphy(TAPP)in 31 cases and total extraperitoneal herniorrhaphy in 10 cases.The reoperative procedures included the TAPP of 11 cases and the Lichtenstein procedure of 30 cases.The factors of recurrent cases in all patients could be divided into 4 categories,including insufficient mesh coverage in 23 cases,mesh curling in 9 cases,mesh contractuture in 7 cases,and improper mesh fixation in 2 cases.Recurrence,infection,chronic pain,foreign body sensation didn′t occur in the followed period of(M(IQR))18(24)months(range:12 to 50 months).There was no statistical difference in the incidence of postoperative seroma between the TAPP and Lichtenstein procedure(3/11 vs.20.0%(6/30),P=0.68).Conclusions Postoperative recurrence of laparoscopic inguinal hernia is mostly caused by the lack of mesh coverage.Due to the emphasis on standardized surgical operation,a good outcome could be achieved through reoperation by the TAPP or Lichtenstein procedure.
作者
刘雨辰
朱熠林
王帆
王明刚
Liu Yuchen;Zhu Yilin;Wang Fan;Wang Minggang(Department of Hernia and Abdominal Wall Surgery,Beijing Chaoyang Hospital Affiliated to Capital Medical University,Beijing 100020,China)
出处
《中华外科杂志》
CAS
CSCD
北大核心
2023年第6期507-510,共4页
Chinese Journal of Surgery
基金
北京市自然科学基金(7222071)。
关键词
疝
腹股沟
腹腔镜检查
复发
治疗结果
Hernia,inguinal
Laparoscopy
Recurrence
Treatment outcome
