腹腔镜下不同术式与开放手术疝修补术治疗腹股沟疝的疗效

目的比较腹腔镜下经腹腔腹膜前疝修补法（TAPP）、完全腹膜外疝修补法（TEP）与开放式无张力疝修补术（Lichtenstein）治疗腹股沟疝的疗效及安全性。 方法选择2015年3月至2017年8月就诊于松滋市人民医院的150例腹股沟疝患者,按照随机数字表法分为3组,Lichtenstein组、TAPP组、TEP组,各50例。对比3组手术相关指标、并发症及术后6个月复发率,并观察围手术期患者应激反应[皮质醇（Cor）、去甲肾上腺素（NE）、醛固酮（ALD）]变化。 结果3组手术时间、术后并发症发生率比较,差异均无统计学意义（P>0.05）;Lichtenstein组术中出血量、术后12 h疼痛数字评分（NRS）、术后下床活动时间及住院时间均比TAPP组和TEP组高,住院费用比TAPP组和TEP组低,差异有统计学意义（P<0.05）;TEP组术后12 h NRS评分、术后下床活动时间及住院费用比TAPP组低,差异有统计学意义（P<0.05）;Lichtenstein组术后3 d Cor、NE及ALD水平,复发率比TAPP组和TEP组高,差异均有统计学意义（P<0.05）。 结论Lichtenstein术治疗腹股沟疝操作相对简单、费用低,腹腔镜下TAPP、TEP术具有应激创伤小、疼痛轻、并发症少、复发率低等特点,临床应结合患者具体病情选择适宜的手术修补方式。     

腹腔镜腹膜前疝修补术与普理灵疝装置无张力疝修补术的比较分析

[目的]比较腹腔镜腹膜前疝修补术（Transabdominal Preperitoneal Herniorrhaphy,TAPP）与普理灵疝装置无张力疝修补术（Prolene Hernia System,PHS）治疗腹股沟疝的疗效。[方法]回顾性分析2008年9月至2010年5月共90例腹股沟疝修补术病例资料,TAPP组36例,PHS组54例。[结果]二者术后并发症均低下;与PHS组相比,TAPP组平均住院时间更短（P〈0.05）,手术时间及手术费用相对较高（P〈0.05）,TAPP另具探查对侧及隐匿疝的独特优势。[结论]TAPP术后住院时间短、恢复快,尤其对复发性疝、双侧疝及隐匿疝更具优势。     

Two cases of early recurrence after transabdominal preperitoneal inguinal hernia repair

We performed transabdominal preperitoneal inguinal hernia repair in 46 patients (58 diseases), two of whom experienced early recurrence after mesh repair. Case 1 was a 76‐year‐old man with a bilateral inguinal hernia (recurrence site, left indirect hernia) after appendectomy. The recurrence occurred 1 month after transabdominal preperitoneal inguinal hernia repair. The mesh was dislocated to the lateral side, and we repaired it using the direct Kugel ® patch with an anterior technique. Case 2 was a 79‐year‐old man with a bilateral inguinal hernia (recurrence site, right direct hernia with an orifice >3 cm) after appendectomy. The recurrence occurred 3 months after transabdominal preperitoneal inguinal hernia repair. The mesh was dislocated to the lateral side, and we repaired it using an ULTRAPRO ® Plug with an anterior technique under laparoscopic observation. We believe the recurrences resulted from insufficient internal exfoliation and fixation affected by complicated exfoliation of the preperitoneal space with omental adhesion after intraperitoneal surgery.     

Interaction of TAPP adapter proteins with phosphatidylinositol (3,4)‐bisphosphate regulates B‐cell activation and autoantibody production

TAPP1 and TAPP2 (where TAPP is tandem PH domain containing protein) are dual PH domain adaptors that selectively bind PI(3,4)P2 (phosphatidylinositol (3,4)‐bisphosphate). PI(3,4)P2 is a lipid messenger generated by phosphoinositide 3‐kinase (PI3K) and SHIP, both of which are critical regulators of B‐cell activation. To determine the functional role of TAPP‐PI(3,4)P2 interactions, we utilized a double knock‐in (KI) mouse bearing mutations within the PI‐binding pocket of both TAPP1 and TAPP2. TAPP KI mice show evidence of altered B‐cell development, but generate phenotypically normal mature B‐cell populations. Total serum immunoglobulin IgM and IgG levels were found to be markedly elevated in TAPP KI mice. B cells purified from TAPP KI mice were hyper‐responsive to antigen receptor cross‐linking, showing increased proliferation, CD86 expression, and Akt phosphorylation on Ser473 and Thr308. Female TAPP KI mice developed elevated levels of anti‐DNA and antinuclear antibodies with age, associated with IgG deposition in kidneys and significant glomerulonephritis pathology. Together our results indicate that interaction of TAPPs with PI(3,4)P2 mediates feedback inhibition impacting on BCR signaling, with functional significance for control of autoreactive B cells.     

Preperitoneal herniation and bowel obstruction post laparoscopic inguinal hernia repair: case report and review of the literature

Laparoscopic inguinal hernia repairs, both transabdominal preperitoneal (TAPP) and total extraperitoneal (TEP), are associated with peritoneal defects or tears. Nonclosure of the tears can lead to bowel obstruction. I present a case of an early (48 h) bowel obstruction related to a peritoneal defect post TAPP inguinal hernia repair. The literature on peritoneal closure and bowel obstruction related to laparoscopic inguinal hernia repair is reviewed as well as options for repairing defects.     

Die „spannungsfreie“ Reparation der Leistenhernie: laparoskopisch (TAPP) versus offen (Lichtenstein)

Zusammenfassung. Im Rahmen einer prospektiven Beobachtungsstudie wurden im Zeitraum Juni 1992 bis Februar 1994 94 Patienten mit 100 Leistenhernien laparoskopisch (TAPP) und von M?rz 1993 bis November 1994 100 Patienten mit 108 Leistenhernien offen mit einem Lichtenstein-Patch versorgt. In bezug auf Operationsdauer, postoperative Schmerzen und Komplikationen sowie Krankenstand wurden nur geringe Unterschiede festgestellt. Aufgrund der schwierig erlern- und lehrbaren Technik wurde die TAPP-Operation nur von einem Operateur, die Lichtenstein-Operation von allen 11 Mitarbeitern durchgeführt, was die Einfachheit des offenen Vorgehens demonstriert. Bislang zeichnet sich eine h?here Rezidivh?ufigkeit für die TAPP-Gruppe (8 vs. 0) ab, wobei jedoch die Lernphase zu berücksichtigen ist. Die Lichtenstein-Operation ist in Lokalanaesthesie einfach auszuführen, leicht erlern- und lehrbar, sicher, effizient und kostensparend (DM 750,–) und deshalb der laparoskopischen Methode überlegen. Eine geplante randomisierte Studie wurde verworfen, laparoskopische Hernienreparationen werden in unserer Klinik seither nicht mehr durchgeführt. Schlüsselw?rter: Laparoskopische Hernienreparation (TAPP) – Lichtenstein-Operation – spannungsfreie Leistenbruchoperation.

---

Summary. In a prospective study, from June 1992 to February 1994 94 patients with 100 hernias were treated laparoscopically (TAPP) and from March 1993 to November 1994 100 patients with 108 hernias were treated with a Lichtenstein patch. Concerning duration of operation, postoperative outcome, complications and return to work, only minor differences were noted. Because of the more demanding and difficult technique, all TAPP procedures were performed by one surgeon, whereas all 11 surgeons of the department performed the Lichtenstein procedure without any learning curve, which demonstrates the simplicity of the procedure. A higher recurrence rate was found for the TAPP procedure (8 vs 0), however the learning curve has to be considered. The Lichtenstein operation is easy to learn and perform, safe, efficient, cheaper (750 DM) and therefore superior to the TAPP procedure. A planned randomized study was cancelled; laparoscopic hernia repair is no longer carried out in our department.

     

Laparoscopic hernioplasty

This study compares the results of two laparoscopic hernioplasties: the transabdominal preperitoneal (TAPP) and the totally extraperitoneal (TEP). Over a 43-month period 1,115 laparoscopic hernioplasties, 733 TAPP and 382 TEP, were performed in 866 patients. There were 11 major complications in the TAPP group (2 recurrences, 6 trocar hernias, 1 small-bowel obstruction, 1 trocar, and 1 dissection injury of the small bowel) compared to 1 recurrence and no intraperitoneal complications in the TEP group. Five TEP procedures required conversion to the TAPP approach, resulting in one umbilical hernia. The median time to return to work did not vary with the approach, but was prolonged in patients compensated for time off, 16 vs 8 days for noncompensated patients.Results suggested that both techniques shortened recovery and eliminated most early failures, but the totally extraperitoneal approach reduced the potential for intraperitoneal complications and may be the procedure of choice in most situations.Presented at the annual meeting of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES), Orlando, Florida, USA, 11–14 March 1995