腹腔镜经腹腹膜前疝修补术联合腹壁小切口“杂交手术”治疗大网膜嵌顿腹股沟疝的临床体会

目的:探讨腹腔镜经腹腹膜前疝修补术(transabdominal preperitoneal,TAPP)联合腹壁小切口治疗大网膜嵌顿性腹股沟疝的临床价值。方法:回顾分析2012年1月至2016年4月明确诊断为大网膜嵌顿疝的13例患者的临床资料,疝囊内网膜组织均不能完全回纳,手术方式为保留远端疝囊内不能回纳的网膜组织,完成TAPP修补,再于腹壁外环处行小切口切除残留疝囊内网膜。结果:13例患者顺利完成手术,手术时间50~120 min,平均(65.9±14.0)min;出血量10~50 ml,平均(13.1±8.2)ml;住院时间4~10 d,平均(6.1±1.1)d。术后1例发生腹股沟血清肿,经保守治疗自行吸收;1例发生阴囊积液,经穿刺后消失;无腹腔出血、腹腔感染、补片感染、肠梗阻及腹股沟区慢性疼痛等并发症。术后随访3~36个月,无复发病例。结论:TAPP联合腹壁小切口的"杂交手术"处理无法回纳的大网膜嵌顿性疝是安全、可行的,可避免不必要的手术中转。

Experience of laparoscopic transabdominal preperitoneal repair combined with abdominal small incision in greater omentum incarcerated inguinal hernia

Objective:To investigate the clinical value of laparoscopic transabdominal preperitoneal (TAPP) combined with abdominal small incision for patients with greater omentum incarcerated inguinal hernia.Methods:Clinical data of 13 patients diagnosed with greater omentum incarcerated inguinal hernia from Jan.2012 to Apr.2016 were retrospectively analyzed.The procedure was to preserve the distal incarcerated omental tissue and perform TAPP firstly and then a small abdominal wall incision was performed to remove the residual contents in the hernia sac.Results:All thirteen cases were performed successfully.The operation time was (65.9±14.0) min (range 50-120 min),the bleeding volume was (13.1±8.2) ml (range 10-50 ml),the hospital stay was (6.1±1.1) d (range 4-10 d).Inguinal seroma occurred in 1 patient and was absorbed spontaneously after conservative treatment.Scrotum effusion occurred in 1 case and was cured after puncture.There were no postoperative complications such as abdominal bleeding,abdominal infection,mesh infection,intestinal obstruction and chronic pain in the inguinal region.The patients were followed up for 3-36 months,no recurrence was found.Conclusions:TAPP combined with abdominal small incision is safe and feasible for management of greater omentum incarcerated inguinal hernia.This method can avoid unnecessary conversion to open operation.