腹腔镜经腹膜腹股沟斜疝无张力修补手术方式的体会（附23例报告）

目的：探讨腹腔镜经腹膜腹股沟斜疝无张力修补手术（TAPP）的方式。方法：显露腹膜前间隙的“三管”（输精管、精索血管和腹壁下血管）和“三带”（Cooper韧带、腹横筋膜带和髂耻束带），将生物补片同定于输精管和精索血管所夹锐角以外的“三带”上。结果：通过抓住“三管”及“三带”结构．把深环周边及腹膜前的复杂解剖关系简单化，把副损伤降低到最低点，使手术时间缩短，操作得心应手。结论：TAPP的操作虽然复杂，但只要吃透腹膜前解剖，抓住重要的解剖要点，可使手术变得相对容易，使更多的腹腔镜医生得以掌握，腹腔镜疝修补术得以推广。     

腹腔镜下经腹腔腹膜前疝修补术中子宫圆韧带的处理

目的探讨针对女性腹股沟疝患者行腹腔镜下经腹腔腹膜前疝修补术(TAPP)中处理子宫圆韧带的方法。方法回顾分析该院普外科自2011年1月-2014年1月,共34例女性腹股沟疝患者行TAPP的临床资料及手术录像,其中,保留子宫圆韧带25例(A组),离断子宫圆韧带9例(B组)。结果 34例手术均顺利完成,A和B两组手术时间分别为(44±8)min和(36±7)min。术后患者均恢复理想,平均随访17个月,无疝复发及慢性疼痛发生。结论与离断子宫圆韧带手术相比,沿子宫圆韧带两侧纵向切开腹膜,保留子宫圆韧带的手术操作相对复杂,用时较长,但可保证子宫圆韧带及腹膜的完整性,临床应用前景及推广价值较高。     

腹腔镜经腹腹膜前应用泰科解剖补片免钉合腹股沟疝修补术的临床应用

目的:探讨腹腔镜经腹腹膜前应用泰科解剖补片免钉合腹股沟疝修补术的临床治疗效果.方法:分析2009 年10 月至2010 年10 月我院采用泰科解剖补片行免钉合(经腹腹膜前疝修补术,TAPP)治疗腹股沟疝的临床资料共53 例,以传统TAPP 术治疗者52 作为对照组,从平均手术时间、术后神经痛、手术区积液、复发再发、手术材料费等方面进行对比.结果:手术均获成功,无中转手术.手术时间为40 ～ 120 min,平均为80 min,住院时间为3 ～ 5 d,平均4 d,手术并发症4 例,均为手术区血清肿,经对症治疗均在1 周内消失,随访6 ～ 18 个月无复发.结论:腹腔镜经腹腹膜前应用泰科解剖补片免钉合腹股沟疝修补术是一种解剖清晰、疗效确切、复发再发率低、手术时间短、损伤小、恢复快、费用低、并发症少、适应证广、设备要求低、易学习掌握、更安全实用的手术方式,值得临床推广普及.     

腹腔镜疝修补术在腹股沟疝治疗中的效果分析

目的总结腹腔镜下经腹腔腹膜前无张力疝修补术(transabdominal preperritoneal prosthetic,TAPP)及全腹膜外补片植入术(Totally Extraperitoneal,TEP)治疗腹股沟疝的临床经验及效果。方法回顾分析2011-01—2014-01应用TEP治疗腹股沟疝的患者23例及TAPP治疗腹股沟疝的患者26例。结果 49例患者均顺利完成手术,无中转开腹病例。手术时间TEP平均105 min。TAPP平均60 min。术后住院2~5 d,平均3.2 d。出血量TEP平均14.3 m L,TAPP平均13.5 m L。对照组采用同时期49例无张力疝修补术(Lichtenstein)患者,两者手术时间、住院时间、出血量差异有统计学意义(P0.05)。结论腹腔镜TEP及TAPP治疗腹股沟疝具有患者创伤小、并发症少等优势。     

三种成人腹股沟疝术式的疗效及手术对术区术后慢性疼痛影响的比较研究

【目的】比校腹腔镜经腹腔腹膜前疝修补术(TAPP)、腹腔镜完全腹膜外补片修补术(TEP)与Lichtenstein修补术(LI)治疗成人腹股沟疝的疗效及手术对术区术后慢性疼痛的影响。【方法】回顾性分析于本院2015年1月至2019年1月初次就诊手术治疗的297例腹股沟疝患者临床资料,根据手术方式的不同将其分为LI组、TAPP组、TEP组,比较三组患者的临床疗效,并比较三种术式对术区术后慢性疼痛的影响。【结果】本研究297例患者中LI组110例,TAPP组127例,TEP组60例。三组患者的术前一般情况无明显差异。三组患者的手术时间、术中出血量、术后首次下床时间均无明显统计学差异。LI组患者的术后住院时间明显长于TAPP组及TEP组(P=0.032),术后切口脂肪液化(P=0.047)及术区慢性疼痛发生率(P=0.045)明显高于TAPP组及TEP组。【结论】与传统开放术式比较,TAPP和TEP疝修补术是治疗成人腹股沟疝的有效术式,术后康复快,且术后术区慢性疼痛发生率少,值得临床推广应用。     

腹腔镜TAPP术治疗复发性腹股沟疝的临床效果

目的探讨腹腔镜经腹腹膜前修补术(TAPP)治疗复发性腹股沟疝的临床效果。方法回顾性分析我院2011年9月至2016年2月行TAPP治疗的腹股沟疝162例患者的临床资料,根据腹股沟疝情况将患者分为原发疝组(142例)与复发疝组(20例)。所有患者在全身麻醉下行腹腔镜TAPP治疗。比较两组的手术时间、术中出血量、术后住院时间、术后并发症发生情况以及复发情况。结果原发疝组的手术时间短于复发疝组(P<0.05);两组的术中出血量及术后住院时间比较,差异无统计学意义(P>0.05)。两组的术后近、远期并发症总发生率及复发率比较,差异无统计学意义(P>0.05)。结论腹腔镜TAPP治疗复发性腹股沟疝可避开前次手术的解剖异常及粘连,疗效可靠,且不增加术后并发症发生率和复发率。     

腹腔镜下全腹膜外疝修补术的围术期护理

正腹股沟疝是普外科常见疾病,手术治疗分开放性无张力疝修补术及腹腔镜疝修补术,目前临床上应用于成人腹外疝的腹腔镜手术方法主要有腹腔内补片平铺术(IPOM)、经腹腹膜前补片植入术(TAPP)、全腹膜外补片植入术(TEP)[1]。TEP手术由美国Mc Kernan于1992年首先报道,直接进入腹膜前间隙而不进入腹腔,是一种腹膜前修补方法,相当于开放式前入路的Kugel手术,在     

腹腔镜经腹腹膜前和全腹膜外腹腔镜疝修补术的临床应用对比研究

目的：比较腹腔镜经腹腹膜前疝修补术（TAPP）与完全腹膜外腹腔镜疝修补术（TEP）治疗成人腹股沟疝的效果。方法回顾分析2007年10月～2013年02月收治的214例（235侧）腹股沟疝患者的临床资料,根据手术方式分为TAPP组58例和TEP组156例,将2组的临床资料进行比较分析。结果TEP组手术时间较短（P＜0.01）、住院费用较低（P＜0.01）。术后下床活动时间、住院时间、术后不适感方面,TAPP组与TEP组差异无统计学意义;TAPP组术中发现隐匿疝4例;术后并发症、复发率,TAPP组和TEP差异无统计学意义。结论TAPP与TEP各具优点,TAPP较TEP更利于发现隐匿疝。但是TEP较TAPP手术时间更短,住院费用更低。     

腹腔镜下两种腹股沟疝修补术治疗腹股沟疝临床疗效分析

目的探讨腹腔镜下两种腹股沟疝修补术治疗腹股沟疝的有效性及安全性。方法回顾性分析2010年3月至2012年8月施行腹腔镜下完全腹膜外腹股沟疝修补术(TEP)的38例成人腹股沟疝患者的临床资料,并与同期施行经腹腔镜腹膜前修补术(TAPP)进行比较分析。结果两组患者住院时间、住院费用、术后下床时间及并发症的发病率均无显著差异(P>0.05);但是手术时间TAPP组长于TEP组,两组比较差异具有统计学意义(P<0.05);TAPP组术后复发2例,TEP组无复发。结论 TAPP和TEP均是治疗成人腹股沟疝的有效方法,但TEP手术时间短,安全性更高,值得临床推广应用。     

TEP、Rutkow及TAPP术式治疗腹股沟疝的效果与安全性对比

目的：对比改良完全腹膜外腹腔镜腹股沟疝修补术（TEP）、疝环充填式疝修补术（Rutkow）与腹腔镜经腹腹膜前疝修补术（TAPP）治疗腹股沟疝的效果与安全性。方法：回顾性分析2019年10月至2021年12月于医院接受手术治疗的84例腹股沟疝患者临床资料,按不同术式分为TEP组（n=29）、TAPP组（n=30）、Rutkow组（n=25）,对比三组手术相关指标、精索静脉管径及血流速、并发症与复发率。结果：三组临床疗效比较,差异无统计学意义（P>0.05）;Rutkow组手术时间短于TEP组、TAPP组,术中出血量、排气时间、住院时间高于TEP组、TAPP组（P<0.05）;三组术前精索静脉管径、精索静脉血流速度及术后精索静脉管径相比,差异无统计学意义（P>0.05）;TEP组术后4周精索静脉血流速度高于TAPP组、Rutkow组（P<0.05）;TEP组、TAPP组并发症发生率低于Rutkow组（P<0.05）;三组复发率相比,差异无统计学意义（P>0.05）。结论：TEP、Rutkow与TAPP均可有效治疗腹股沟疝且复发率低,但TEP对精索静脉损伤...     

An inguinal hernia that arose after robot-assisted radical prostatectomy and the repair of an intraoperative external iliac vein injury: A case report

This case involved a 63-year-old man. He underwent robot-assisted radical prostatectomy (RARP) for prostate cancer. One year after the operation, he consulted our hospital about left inguinal swelling. Under a diagnosis of a left external inguinal hernia, transabdominal preperitoneal repair (TAPP) was performed under general anesthesia. The inside of the hernia orifice had been damaged by the RARP, and the resultant fibrosis was so marked that it was difficult to dissect the preperitoneal space. Furthermore, an external iliac vein injury occurred during the operation. The bleeding was controlled, and we used laparoscopic continuous non-absorbable sutures to repair the external iliac vein injury. The number of TAPP procedures performed after radical prostatectomy has been increasing in recent years, but dissecting the preperitoneal space inside a hernia orifice is difficult. Although external iliac vein injuries are rare complications of TAPP procedures, they can be laparoscopically repaired.     

经腹腹腔镜腹股沟疝修补术51例报告

目的探讨经腹腹腔镜腹股沟疝修补术（TAPP）的临床应用和经验。方法回顾分析接受TAPP手术患者的临床资料、手术时间、住院时间及治疗结果、并发症。结果共有51例58侧腹股沟疝接受TAPP手术,3例合并胆囊病变同时行腹腔镜胆囊切除术。32例单侧疝,无并发病者,手术时间50～90min,平均75．6min;住院时间4．7d,平均5．5d。术后出现腹股沟区疼痛2例（2／58,3．4％）,腹股沟区积液血肿7例（7／58,12．1％）。经8～60个月的随访,无一例复发,无粘连性肠梗阻发生。结论TAPP治疗腹股沟疝是安全有效的。     

Development of scar-less laparoscopic hernia repair (TAPP-252) facilitated by new 2mm instruments

Introduction: To minimize the invasiveness of laparoscopic transabdominal preperitoneal hernia repair (TAPP) for the treatment of adult inguinal hernia, we developed a new operative technique with the use of only one 5?mm port and two 2?mm punctures (TAPP-252).

Material and methods: To facilitate TAPP-252, we developed seven kinds of new 2?mm instruments, including grasping forceps, hook shaped electrode, mesh pusher, needle driver, scissors, laparoscope and port.

Results: TAPP-252 was stably performed in 35 patients with minimal abdominal wall destruction and excellent cosmetic result without any recurrence or morbidity.

Conclusions: The newly developed 2?mm devices showed sufficient performance and durability in TAPP-252. Further investigation is necessary to assess durability and long-term outcomes.     

Mesh shrinkage is the potential pathogenesis of chronic somatic pain following transabdominal preperitoneal repair: Report of two cases

Although mesh-related pain, termed “somatic pain,” is a well-known pain syndrome following Lichtenstein repair, few reports are available on somatic pain following transabdominal preperitoneal repair (TAPP) and its pathogenesis remains unclear. We report on two patients with refractory somatic chronic pain following TAPP. In the present two cases, both mesh fixation with rigid permanent metal tackers and mesh shrinkage resulting in contractile forces on the groin musculature could be considered as potential mechanisms in the etiology of chronic somatic pain following TAPP. The lessons learned from these two cases are: (a) mesh shrinkage resulting in contractile forces on the groin musculature could be considered as potential mechanisms in the etiology of chronic somatic pain following TAPP; (b) partial mesh removal would be an effective alternative to total mesh removal in those patients for remedial surgery.     

TAPP和Kugel疝修补术临床效果比较分析

目的比较TAPP和Kugel手术方式在治疗成人腹股沟疝中的效果。方法将152例患者随机分成两组,一组接受TAPP手术,另一组接受Kugel手术,比较两组短期并发症,手术时间及住院时间等方面的指标。结果 TAPP组术后1周并发症明显少于Kugel组(χ2=0.83,P<0.05);手术时间、术后住院时间较Kugel组缩短(t分别=1.99、2.36,P均<0.05);TAPP组术后疼痛程度较轻,使用止痛药物次数较少(χ2=1.72,P<0.05)。结论 TAPP术是一种更为简单、微创、安全,恢复快的手术方式。     

Laparoscopic transabdominal preperitoneal repair for strangulated inguinal hernia

Introduction

Laparoscopic transabdominal preperitoneal repair (TAPP) is widely accepted in elective inguinal hernioplasty. However, given the scarcity of data, the feasibility and safety of TAPP in strangulated hernia cases have not yet been determined.

Methods

We retrospectively evaluated the data from a consecutive series of 33 patients who had undergone surgery for acute strangulated inguinal hernia associated with suspected visceral ischemic damage by either TAPP (TAPP group, n = 11) or conventional open hernioplasty via the anterior approach (anterior group, n = 22).

Results

The TAPP group had a significant longer surgical duration than the anterior group (147 vs 84 min) and relatively less blood loss. Incision and enlargement of the hernial orifice, which enables easy reduction of the strangulated organ, was performed in the last 7 of 11 cases in the TAPP group. The morbidity was lower in the TAPP group, but the difference was not statistically significant (18% vs 23%). The TAPP group had a significantly shorter postoperative hospital stay than the anterior group (7 vs 10 days).

Conclusion

For surgeons with sufficient knowledge of the anatomy and expertise in reducing the strangulated organ, TAPP for strangulated inguinal hernia is at least comparable to open hernioplasty via the anterior approach in short‐term outcomes.     

腹腔镜经腹腹膜前疝修补术术中应用纱块钝性分离腹膜前间隙的效果分析

目的探讨腹腔镜经腹腹膜前疝修补术（TAPP）术中应用纱块钝性分离腹膜前间隙的效果。 方法回顾性分析2017年1月至7月佛山市南海区人民医院行TAPP治疗的腹股沟疝136例。根据手术器械的不同将患者分为纱块游离组（36例）和直接游离组（100例）。采用t检验比较2组患者游离腹膜前间隙所花费的时间、出血量的差异，采用χ²检验比较2组患者术中腹膜破损发生率的差异。 结果136例患者术后通过门诊复诊及电话随访1年均未复发。纱块游离组患者平均手术时间短于直接游离组[（18.97±2.86）min vs（24.84±4.25）min]，出血量少于直接游离组[（6.29±2.82）ml vs（8.94±4.17）ml]，腹膜破裂发生率低于直接游离组[3.03%（3/36）vs 25.00%（25/100）]，2组比较差异均具有统计学意义（t=-9.181，P=0.027；t=-4.212，P=0.001；χ²=4.497，P=0.034）。 结论TAPP术中应用钳夹纱块钝性分离腹膜前间隙，可以缩短手术时间，减少术中出血量，术中腹膜破损的发生率也较低。     

Sonographic “speech bubble/speech box sign” in clinically occult femoral hernias: ultrasound findings and anatomical basis

Femoral hernia is the protrusion of a peritoneal sac through the femoral ring into the femoral canal lying deep and inferior to the inguinal ligament. The hernia sac usually contains preperitoneal fat, omentum, bowel, or fluid. Ultrasound is recommended as the first-line investigation for diagnosing clinically occult femoral hernias in nonemergency settings, whereas CT is the imaging of choice in emergency settings. High accuracy of the ultrasound in clinically occult femoral hernia is further validated with further CT and MRI. In this article, we propose sonographic detection of the physiological peritoneal fluid herniating through capacious femoral ring manifesting as a “speech bubble/speech box appearance.” This is a potentially invaluable sonographic sign for clinically occult femoral hernias, differentiating them from inguinal hernias and cysts of the canal of Nuck in females and preventing inadvertent attempts to aspirate.     

LAPAROSCOPIC HERNIOPLASTY

这篇来自德国的文章 ,作者是德国微创外科学会主席、南德外科学会主席 ,德国《外科胃肠病学杂志》主编BITTNER教授。他及他的同事共计施行了腹腔镜疝修补术近 1万例 ,取得了巨大的成就 ,目前在腹外疝的微创外科治疗领域中处于世界领先地位。作者的这篇文章是专为本刊而作 ,文章中有许多新概念、新理论和新技术 ,希望读者能够从中得到收获