改良腹腔镜经腹腔腹膜前腹股沟疝修补术

目的探讨改良后的腹腔镜经腹腔腹膜前腹股沟在成人疝修补中的应用价值。方法2006年5月至2008年4月，对腹股沟疝403例、股疝22例行改良TAPP术。剪开脐外侧韧带，斜疝患者以缝合小儿疝的方法关闭内环口，直疝疝囊、股环疝囊予以剥离、置补片，游离的脐外侧韧带腹膜全部覆盖网片，钉合及可吸收线以针织的方法固定。结果手术无中转，每侧手术时间20～30min，出血量约4～5ml，随访时间2～22个月，无复发，无腹部牵拉不适，也无腹痛、腹胀、恶心等肠梗阻及尿频、尿痛等膀胱刺激症状。结论改良经腹腹膜前（TAPP）腹腔镜腹股沟疝修补术方法简单、效果确切、创伤小、并发症少、费用低，值得临床推广应用。

The improvement of transabdominal preperitoneal repair for groin hernias

Objective Because of separating indirect hernia sac and peritoneum extensive, stapling of peritoneum, the transabdominal preperitoneal （TAPP） repair for groin hernias increased not only the difficulty and the time of the surgical operation, but also the expenses, making the laparoseopic hernia repair hard to carry out extensively in our country. To slove these prombles ,we had modified the method of TAPP in order to overcome the shortage of that method and explored the value of the modified method in hernia repair. Methods From May 2006 to April 2008,modified TAPP repair for hernia was performed on 403 adult patients with groin hernia and 22 with temoral hernia. Indirect hernia sac were treated with high ligation of hernia sac just as the method of the hernia in children＇ s, while direct and temoral hernia were treated with disstecting the hernia sac. An incision was made on the lateral umbilical ligament. The mesh was stapled and recovered by the peritoneum of the lateral umbilical ligament completely. Staple and absorbed silk were used in the way as weaving. Results All the operations were accomplished successfully with operating time from 20 to30 minutes for unilateral hemioplasty. Losing blood volume was 4 to 5 ml. There was no recurrence ＇after 2 to 22 months follow-up. Also there was no abdominal uncomfortable, no abdominal pain, no nausea that something like intestinal obstruction and no frequent micturition, no odynuria. Conclusions The modified laparoscopic transabdominal preperitoneal repair for groin hernias can be characterized by advantages of simplicity of performance, reliability, minimal invasion, less complications, and also helps to reduce the cost of the operation, so it was worth recommending for wide application.