腹腔镜下完全腹膜外补片植入术治疗腹股沟疝的手术技巧

目的:探讨腹腔镜下完全腹膜外补片植入术(totally extraperitoneal prosthesic,TEP)治疗腹股沟疝的手术技巧。方法:对2004年4月至2006年8月我院实施TEP的269例(294例次)腹股沟疝患者的临床资料进行回顾性分析,并对手术技巧进行总结。结果:手术均获成功,未中转其他术式,平均手术时间(63.1±37.5)m in,平均住院时间(3.7±1.4)d,恢复天数(7.3±1.6)d;术中出血量(12.3±8.2)m l,腹膜撕裂发生率为8.16%(24/294);术后皮下气肿发生率为3.06%(9/294),腹股沟血肿发生率为2.38%(7/294),异物感发生率0.68%(2/294),术后未出现持续性神经性疼痛、切口感染及补片感染;3例出现复发,复发率为1.02%(3/294)。结论:熟练掌握腹股沟解剖,运用合理的手术技巧和规范的操作,可以有效缩短学习曲线,减少手术时间,降低术中、术后并发症的发生。

The surgical skill of totally extraperitoneal laparascopic herniorrhaphy

Objective:To explore the surgical skill of totally extraperitoneal laparoscopic herniorrhapy.Methods:The clinical data of 269 patients underwent totally extraperitoneal laparoscopic herniorrhapyh from April 2004 to August 2006 were analyzed retrospectively and the surgical skill was summarized.Results:All operations were performed successfully.The mean operation time was(63.1±37.5)min,the mean hospital stay was(3.7±1.4)d,the mean time of recovery was(7.3±1.6)d,and the mean blood loss was(12.3±8.2)ml.The ratio of peritoneum laceration,subcutancous emphysema after operation,inguinal hematoma and foreign body sensation were 8.16%(24/294),3.06%(9/294),2.38%(7/294) and 0.68%(2/294) respectively.There were no complications of persistent nervous pain,wourd infection and onlay mesh infection after operations.The recurrence rate was 1.02%(3/294).Conclusions:With the skilled laparoscopic anatomy,the suitable use of surgical skill and normative manipulation,we can shorten the learing curve and operative time.At the same time The intraoperative and postoperative complications can also be lowered.