经腹腹腔镜腹股沟疝修补术56例报告

目的探讨经腹腹腔镜腹股沟疝修补术（TAPP）的方法。方法回顾分析接受TAPP手术患者的临床资料、手术时间、住院时间以及治疗结果、并发症。结果共有48人56例腹股沟疝接受了TAPP手术，6例合并胆囊病变同时行腹腔镜胆囊切除术。24例单侧驰且无并发病者，手术时间40-90min，平均70．8min；住院时间4-7d。平均5．5d。术后出现腹股沟区疼痛1例（1／56，1.8％），腹股沟区积液血肿5例（5／56，8．9％）。经2—14个月的随访，术后复发1例（1／56，1．8％），无粘连性肠梗阻病例发生。结论TAPP治疗腹股沟疝是安全有效的。     

比较经腹腔镜疝修补术与传统开放式疝修补术治疗腹股沟疝

目的:分析经腹腔镜疝修补术与传统开放式疝修补术治疗腹股沟疝的临床疗效。方法:回顾性分析2016年1月～2019年1月就诊的109例腹股沟疝患者的临床资料,根据术式不同分为A组(n=56)与B组(n=53)。A组采用经腹腔镜疝修补术治疗,B组采用传统开放式疝修补术治疗,比较两组手术指标和胃肠动力指标。结果:A组手术时间、住院时间、术后下床时间显著短于B组,术中出血量少于B组(P<0.05)。A组术后血清胃动素、胃泌素水平显著高于B组(P<0.05)。结论:与传统开放疝修补术相比,经腹腔镜疝修补术具有微创、恢复快的优点,可有效改善患者的胃肠动力,是一种安全有效的治疗手段,但传统开放式疝修补术是最经典且最常用的腹股沟疝修补术式,尤其适合小儿腹股沟疝、经济困难的巨大疝或者不能耐受气腹的高龄腹股沟疝患者,临床应根据实际情况选择术式。     

腹腔镜下腹股沟疝修补术

１临床资料与方法１．１临床资料３８例病人，女性２例，男性３６例，年龄最小的为１岁１１个月，最大的为７２岁，平均年龄３４．４岁。２例为腹股沟直疝，其余３６例为腹股沟斜疝。其中有４例为复发性斜疝。１例病人在静脉麻醉下进行，１８例在气管插管全麻下进行，１９...     

腹腔镜经腹膜前腹股沟疝修补术的临床应用价值

目的 研究腹腔镜经腹膜前腹股沟疝修补术(TAPP)在临床应用中的价值.方法 回顾性分析32例TAPP和56例开放式无张力疝修补成人腹股沟疝病人资料,并对手术后1～36个月的病人进行电话随访.分析指标:手术时间、镇痛剂使用频次、术后住院天数、内脏血管损伤、阴囊气肿、阴囊水肿、切口感染、有无复发、住院费用.结果 镇痛荆使用频次、阴囊水肿发生率、术后住院天数,TAPP优于无张力疝修补术,两组比较差异有统计学意义(P＜0.05);手术时间、住院费用,TAPP不如无张力疝修补术,两组比较差异有统计学意义(P＜0.05);阴囊气肿是腹腔镜腹股沟疝修补术所特有;两组均无内脏血管损伤、切口感染、疝复发发生.结论 TAPP是一种安全、有效的无张力疝修补方法.比较开放式无张力疝修补术,TAPP具有创伤小、疼痛轻、恢复快等优势,但也存在费用高等缺点.对于复发疝和双侧疝,可优先考虑腹腔镜疝修补.     

腹腔镜下经腹腔腹膜前疝修补术与无张力疝修补术治疗腹股沟疝疗效观察

目的 探究腹腔镜下经腹腔腹膜前疝修补术(TAPP)和无张力疝修补术治疗成人腹股沟疝的疗效差异及对患者疼痛程度的影响.方法 选取2019年11月至2020年2月广州开发区医院收治的104例成人腹股沟疝患者,进行前瞻性研究.按照随机数字表法分为对照组和观察组,各52例.对照组患者接受无张力疝修补术治疗,观察组患者接受腹腔镜...     

腹腔镜下腹股沟疝修补术治疗腹股沟疝的临床疗效分析

目的探讨腹腔镜下腹股沟疝修补术治疗腹股沟疝的临床疗效。方法选取我院2017年7月至2018年12月期间收治的腹股沟疝患者80例,用随机数字法对照组和观察组各40例。对照组接受开放式无张力疝修补术治疗,观察组接受腹腔镜下腹股沟疝修补术治疗,观察比较两组治疗疗效。结果观察组并发症总发生率为5.00%,低于对照组的40.00%,差异有统计学意义(P0.05);两组患者手术时间比较,差异无统计学意义(P0.05);观察组住院费用高于对照组,下床活动时间、痛感持续时间、住院时间低于对照组,差异均有统计学意义(P0.05)。结论腹腔镜下腹股沟疝修补术治疗腹股沟疝,创伤小,疼痛程度轻,术后恢复速度快,值得推广。     

腹腔镜经腹腹膜前修补术治疗腹股沟疝的效果观察

目的探讨腹腔镜经腹腹膜前修补术治疗腹股沟疝的临床效果。方法选取2016年2月至2019年5月在灵宝市第一人民医院治疗的腹股沟疝患者82例,参照随机数字表法分为对照组和观察组,每组41例。对照组患者采用腹腔镜全腹膜外疝修补术治疗,观察组患者采用腹腔镜经腹腹膜前修补术治疗,观察分析两组患者的临床指标(手术时间、术中出血量)及复发(斜疝、直疝、股疝、复合疝)情况。结果观察组患者手术时间及术中出血量低于对照组患者,差异有统计学意义(P 0. 05)。观察组患者术后复发率为12. 20%(5/41),对照组为14. 63%(6/41),差异未见统计学意义(P 0. 05)。结论对腹股沟疝患者采用腹腔镜经腹腹膜前修补术治疗效果显著,能够减少术中输血量,缩短术后住院时间,降低术后复发率。     

传统腹股沟疝修补术、无张力疝修补术及腹腔镜疝修补术的对比研究

选取腹股沟疝患者150例,随机分为三组,分别选用传统腹股沟疝修补术,无张力疝修补术及腹腔镜疝修补术进行治疗并进行对比研究。传统组相对于无张力组及腹腔镜组术后疼痛持续时间、住院时间、切口愈合时间及恢复正常工作时间均相对较长。腹腔镜疝修补术及无张力疝修补术的治疗效果优于传统腹股沟疝修补术。     

经腹腔镜腹股沟疝修补术

为20例22例疝行腹腔镜声修补术，其中斜疝14例、隐性疝5例、直疝1例。行疝囊高位结扎5例、用经腹腔腹膜前铺网固定法修补15例17侧疝。对手术方法及防止复发的操作要点进行了讨论。     

腹腔镜下经腹腔腹膜前修补术治疗成人腹股沟疝的护理

腹腔镜疝修补手术是一种微创的无张力疝修补手术方法。2004年5月至2008年4月,我院采用腹腔镜下经腹腔腹膜前内置补片疝修补术（transabdominal preperitoneal prosthetic,TAPP）治疗成人腹股沟疝72例,取得明显效果,现将护理体会报告如下。     

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.     

腹股沟疝Lichtenstein修补术与腹膜前修补术的对照研究

目的比较腹股沟疝Lichtenstein修补术与腹膜前修补术这两种腹股沟疝修补术的优缺点。方法回顾性分析2005年1月至2008年12月行Lichtenstein修补术患者114例和腹膜前修补术152例手术时间、住院时间、术后不适感、术后并发症、复发等资料。结果两种术式在住院时间、术后并发症、复发率等方面差异无统计学意义;Lichtenstein修补术手术时间较腹膜前修补术短,但术后不适感主诉较多;腹膜前修补的费用较高。结论两种术式各有优缺点,均可用于腹股沟疝的修补。     

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.     

经腹腹膜前腹腔镜疝修补术的并发症防治

目的探讨经腹腹膜前腹腔镜腹股沟疝修补术(TAPP)的手术效果与并发症的防治。方法回顾分析2003年3月~2004年10月接受TAPP手术患者的临床资料以及治疗结果、并发症。结果共有100人123例次施行了TAPP术,其中合并胆囊病变及慢性阑尾炎各为12及1例,同时行腹腔镜胆囊切除术及阑尾切除术;50例单侧疝且无并发病的手术时间(65.7±14.8)min,住院时间(5.3±0.9)d;123例中术后腹股沟区疼痛1例,腹股沟区血清肿及血肿8例;经3~23个月的随访,术后复发1例,无腹股沟区慢性疼痛病例,无粘连性肠梗阻病例。结论TAPP治疗腹股沟疝是安全有效的,并发症及复发率可以接受。     

自固定补片"Y形"铺置法在女性腹股沟疝经腹腹膜前修补术中的应用

目的探讨自固定补片"Y"形铺置法在腹腔镜女性腹股沟疝经腹腹膜前修补术(laparoscopic transabdominal preperitoneal repair of inguinal hernia,TAPP)中的效果。方法选取2019年2月至2020年9月陕西省人民医院行腹腔镜TAPP手术(keyhole法)的女性腹股沟疝患者共40例,采用前瞻性队列研究,依据补片铺置方法的不同分为"Y"形铺置法组21例、常规法组19例,比较两组患者手术时间、补片铺置时间、术后住院时间、术后1 d的VAS评分及术后并发症情况。结果40例患者均完成TAPP手术,所有患者均顺利完成随访,中位随访时间12.5个月。"Y"形铺置法组手术时间及补片铺置时间分别为(54.9±9.0)、(10.8±2.5)min,常规法组分别为(62.8±11.2)、(20.3±3.5)min;两组比较差异均有统计学意义(t=2.490、P=0.017;t=9.925、P<0.001)。两组患者术后住院时间、术后1 d VAS评分、术后并发症比较差异均无统计学意义(P均>0.05)。结论在腹腔镜女性腹股沟疝修补术(keyhole法)中,"Y"形铺置法可有效缩短自固定补片铺片时间,从而缩短手术时间,且并不增加并发症的风险,具有一定优势。     

开放式腹膜前间隙修补术与Lichtenstein修补术治疗腹股沟疝的比较研究

目的对比研究开放式腹膜前间隙修补术与Lichtenstein修补术治疗腹股沟疝的临床疗效。方法选择287例腹股沟疝患者,其中130例行开放腹膜前间隙修补(TEP)术(研究组),157例行Lichtenstein术(对照组)。比较两组平均手术时间、平均术后住院时间、术后恢复时间、并发症发生率和复发率。结果研究组平均手术时间、平均术后住院时间、术后恢复时间均低于对照组,但均无统计学差异(P0.05)。研究组切口感染、腹股沟区疼痛、神经感觉异常和阴囊水肿的发生率均显著低于对照组,差异具有统计学意义(P0.05)。术后随访1年内对照组复发7例,研究组复发1例,研究组复发率显著低于对照组(P0.05)。结论与Lichtenstein修补术相比,开放TEP术治疗腹股沟疝具有术后并发症少、复发率更低等优点,值得推广应用。     

Laparoscopic repair via the transabdominal preperitoneal procedure for bilateral lumbar hernia: Three cases report and review of literature

A lumbar hernia is a rare entity, and a bilateral lumbar hernia is much rarer. From May 2015 to October 2017, we treated only three patients with bilateral lumbar hernias. One patient came to the hospital presenting with right-sided abdominal pain, and the other two patients presented with bilateral lumbar masses. The previous bilateral lumbar hernia reported in the literature was repaired by open surgery. The laparoscopic approach via the transabdominal preperitoneal (TAPP) procedure with the self-gripping Parietex ProGrip™ mesh was performed at our center. The laparoscopic repair was conducted by a skilled hernia surgeon, and was successfully performed in the three patients. The patients resumed a semi-liquid diet and had no activity restriction after six hours following the operation. No antibiotics were used after the surgery. The operative times of the three patients were 120 min, 85 min, and 130 min. The blood loss volumes of the three patients were 20 mL, 5 mL, and 5 mL. The visual analogue scale pain scores of the three patients were 1, 2, and 2 on postoperative day 1, and were 1, 2, and 1 on postoperative day 3. No perioperative complications, such as bulge, wound infection and hematoma, occurred after the surgery. All of the patients were discharged on the third day after the operation. There was no chronic pain and no hernia recurrence during the follow-up. This study showed that the laparoscopic TAPP approach with the self-gripping mesh is safe and feasible, and can be considered an alternative method for the treatment of bilateral lumbar hernias.     

腹膜前单层网片无张力疝修补术临床应用

目的 探讨经腹膜前单层网片无张力疝修补术的临床疗效.方法 回顾性分析解放军411医院2008年1月至2012年12月356例患者采用经腹膜前单层网片无张力疝修补术的临床资料.结果 全组患者术后均痊愈,无局部异物感,无感染,随访无复发.结论 经腹膜前单层网片无张力疝修补术是对腹股沟区的全面修补,该手术是一种安全有效的手术方式,是治疗腹股沟疝的一种合理的手术方式.