腹腔镜经腹腔腹膜前腹股沟疝修补术与Lichtenstein疝修补术对比研究

目的比较腹腔镜经腹腔腹膜前腹股沟疝修补术(TAPP)与Lichtenstein修补术治疗腹股沟疝的临床应用价值。方法分别对46例接受TAPP手术与140例接受Lichtenstein修补术的腹股沟疝患者的临床资料进行回顾性分析。结果两组在手术时间、术后下床活动时间、生活自理时间、住院天数、恢复日常工作天数方面,均无显著性差异(P0.05),两组术后均无复发。结论腹腔镜经腹腔腹膜前腹股沟疝修补术与Lichtenstein修补术均为腹股沟疝的良好修补法,但复发疝、双侧疝及腹腔联合手术的患者更适合选择腹腔镜手术。     

内镜联合腹腔镜治疗重症急性胰腺炎并发胰腺假性囊肿的临床疗效观察

目的：探讨内镜联合腹腔镜治疗重症急性炎（SAP）并发胰腺假性囊肿（PPC）的临床疗效。方法：选取2012年6月—2014年3月在手术治疗的52例SAP并发PPC患者临床资料,其中31例行内镜联合腹腔镜手术治疗（内镜-腹腔镜组）,21例行采用开腹手术治疗（开腹组）。比较两组患者术中治疗情况、术后疗效、恢复及并发症发生的情况。结果：内镜-腹腔镜组手术时间、术中出血量、术后排气时间及术后住院时间均明显少于开腹组（均P<0.05）;两组治疗有效率和术后并发症发生率差异无统计学意义（均P>0.05）;内镜-腹腔镜组术后疼痛、恶心、呕吐发生率均明显低于开腹组（均P<0.05）。随访半年后,两组患者均无PPC复发。结论：采用内镜联合腹腔镜治疗SAP并发PPC,疗效显著,安全性好,可根据患者具体情况形成个体化治疗策略,值得临床应用。

     

胆道结石再手术治疗56例临床体会

目的：探讨胆道结石再手术治疗的策略。
方法：回顾分析1999—2006年收治的56例胆道结石再手术治疗患者的临床资料。
结果：患者均经再手术治疗。术后残留结石3例（5.4%）,其中2例术后6周通过胆道镜取石成功。出现并发症9例（16.1%）,均经非手术疗法治愈。无围手术期死亡。42例随访1~7年,发现有胆管炎发作者2例,结石复发1例,无须再手术治疗者。
结论：严格掌握手术方式的选择,全面正确的术前诊断和充分的术前准备,胆道残留或复发结石再手术是安全有效的。

     

腹腔镜联合经肛门括约肌间超低位直肠癌切除术：附68例报告

目的：探讨腹腔镜联合经肛门括约肌间径路超低位直肠癌切除的可行性。方法：回顾2010年1月—2012年6月68例行腹腔镜经肛门括约肌间径路超低位直肠癌根治术患者（腔镜组）与同期行76例开腹经肛门括约肌间径超低位直肠癌根治术患者（开腹组）的临床资料,比较两组临床指标与疗效。结果：144例手术均获成功,腔镜组无中转开腹。与开腹组比较,腔镜组手术时间延长[（243.7± 40.4）min vs.（150.5±32.1）min],但术中出血量减少[（103.2±10.5）mL vs.（231.6±23.5）mL]、术后切口感染例数减少（1例 vs. 8例）、肛门排气时间缩短[（2.5±0.6）d vs.（4.6±0.5）d]、住院天数减少[（10.5±0.4）d vs.（14.6±0.3）d],差异均有统计学意义（均P<0.05）;两组扫淋巴结数目、吻合口瘘与肠梗阻发生例数,以及术后1年生存率差异均无统计学意义（均P>0.05）。结论：腹腔镜应用于经肛门括约肌间径路超低位直肠癌手术安全可行,并有微创、术后切口感染少等优点。

     

腹腔镜规则性左半肝切除联合胆道镜取石治疗肝内外胆管结石

目的：探讨腹腔镜下规则性左半肝切除联合胆道镜取石治疗肝左叶肝内胆管结石合并胆总管结石的临床疗效。 方法：回顾性分析2010年3月—2013年9月间收治的12例肝内外胆管结石患者的临床资料。患者术前均明确诊断为左肝内广泛胆管结石合并胆总管结石,均行腹腔镜规则性左半肝切除联合胆总管切开胆道镜取石术。 结果：所有手术均顺利完成,无中转开腹。手术用时（182.6±36.3）min,术中出血（213.5±65.5）mL,术后肛门排气时间（38.5±8.2）h,术后平均住院时间（10.3±3.1）d。术后发生肝断面出血1例,胆瘘1例,均通过保守治疗痊愈。随访时间3个月至3年,平均23个月,未发现胆道结石残留或再生。 结论：对于肝左叶广泛肝内胆管结石合并胆总管结石的患者,腹腔镜规则性左半肝切除联合胆道镜行胆总管切开取石术是安全有效的手术方式。

     

单侧复发性腹股沟疝腔镜下修补的临床分析

目的探讨单侧复发性腹股沟疝腔镜下修补术的临床体会。 方法回顾性分析2009年1月至2019年1月，福建医科大学附属第一医院收治的123例腔镜下修补单侧复发性腹股沟疝患者的临床资料。通过手术时间、有无中转手术、发生副损伤、术后第1天疼痛评分、术后住院时间、术后并发症发生情况，分析腔镜修补单侧复发性腹股沟疝的临床效果。 结果123例单侧复发性腹股沟疝患者，采用腹腔镜完全腹膜外疝修补术（TEP）患者54例，采用腹腔镜经腹腹膜前疝修补术（TAPP）患者59例，采用腹腔内修补术（IPOM）患者10例。平均手术时间（50.68±9.46）min，术后第1天视觉模拟疼痛评分（2.19±1.76）分，术后住院时间（2.25±1.40）d。术后累计并发症患者12例（9.76%），均治愈出院，随访时间内无复发。 结论腔镜修补手术（TEP、TAPP及IPOM）是治疗复发性腹股沟疝安全有效的方法，可以在有条件的单位开展。     

倾向得分匹配法对两种方法治疗胆总管结石的疗效再评价

目的：再评价腹腔镜胆总管探查术与开腹手术治疗胆总管结石的疗效。 方法：收集我院2012年1月—2014年1月手术治疗的92例胆总管结石患者临床资料,其中34例行腹腔镜胆总管探（腹腔镜组）,58例行开腹手术（开腹组）,采用倾向得分匹配法（PSM）均衡组间混杂因素的影响,比较匹配后两组患者的临床指标。 结果：经PSM法成功匹配30对患者,所有基线资料在组间分布均衡。两组患者的手术时间差异无统计学意义（P=0.190）,腹腔镜组术中出血量明显少于开腹组,且胃肠功能恢复时间及住院时间也明显短于开腹组,差异均有统计学意义（均P<0.05）;两组患者术后并发症发生率差异无统计学意义（P>0.05）。 结论：腹腔镜胆总管探查术治疗胆总管结石较开腹手术具有微创,术中失血少,术后恢复快,住院时间短,再评价结果与以往研究一致。

     

腹腔镜下不同术式与开放手术疝修补术治疗腹股沟疝的疗效

目的比较腹腔镜下经腹腔腹膜前疝修补法（TAPP）、完全腹膜外疝修补法（TEP）与开放式无张力疝修补术（Lichtenstein）治疗腹股沟疝的疗效及安全性。 方法选择2015年3月至2017年8月就诊于松滋市人民医院的150例腹股沟疝患者,按照随机数字表法分为3组,Lichtenstein组、TAPP组、TEP组,各50例。对比3组手术相关指标、并发症及术后6个月复发率,并观察围手术期患者应激反应[皮质醇（Cor）、去甲肾上腺素（NE）、醛固酮（ALD）]变化。 结果3组手术时间、术后并发症发生率比较,差异均无统计学意义（P>0.05）;Lichtenstein组术中出血量、术后12 h疼痛数字评分（NRS）、术后下床活动时间及住院时间均比TAPP组和TEP组高,住院费用比TAPP组和TEP组低,差异有统计学意义（P<0.05）;TEP组术后12 h NRS评分、术后下床活动时间及住院费用比TAPP组低,差异有统计学意义（P<0.05）;Lichtenstein组术后3 d Cor、NE及ALD水平,复发率比TAPP组和TEP组高,差异均有统计学意义（P<0.05）。 结论Lichtenstein术治疗腹股沟疝操作相对简单、费用低,腹腔镜下TAPP、TEP术具有应激创伤小、疼痛轻、并发症少、复发率低等特点,临床应结合患者具体病情选择适宜的手术修补方式。     

腹腔镜经腹腹膜前修补术在复发性腹股沟疝的应用

目的探讨复发性腹股沟疝应用腹腔镜经腹腹膜前修补手术（TAPP）的安全性及治疗效果。 方法回顾性分析2019年1月至2021年6月南京大学医学院附属鼓楼医院采用TAPP术式治疗的52例患者资料,通过术中观察、有无中转及术后并发症（血清肿、术后疼痛）、术后留院时间等,分析复发原因及腹腔镜手术的临床效果。 结果52例中原位复发18例（34.62%）,新发34例（65.38%）,TAPP术中转开放手术3例（5.77%）,并发症发生5例（9.62%）,无严重并发症发生,所有患者均顺利出院。 结论腹腔镜下TAPP疝修补术应用于前入路腹股沟疝修补术后的复发疝是安全可靠的,具有可行性,仔细操作可以避免副损伤及其他严重并发症。     

Recurrent inguinal hernia: randomized multicenter trial comparing laparoscopic and Lichtenstein repair

Background The optimal treatment for recurrent inguinal hernia is of concern due to the high frequency of recurrence. Methods This randomized multicenter study compared the short- and long-term results for recurrent inguinal hernia repair by either the laparoscopic transabdominal preperitoneal patch (TAPP) procedure or the Lichtenstein technique. Results A total of 147 patients underwent surgery (73 TAPP and 74 Lichtenstein). The operating time was 65 min (range, 23–165 min) for the TAPP group and 64 min (range, 25–135 min) for the Lichtenstein group. Patients who underwent TAPP reported significantly less postoperative pain and shorter sick leave (8 vs 16 days). The recurrence rate 5 years after surgery was 19% for the TAPP group and 18% for the Lichtenstein group. Conclusion The short-term advantage for patients who undergo the laparoscopic technique is less postoperative pain and shorter sick leave. In the long term, no differences were observed in the chronic pain or recurrence rate.     

谈腹股沟疝腔镜的腹膜外修补操作技术

腔镜腹股沟疝腹膜外修补技术(TAPP)不同于常规的开放手术,有着独特的视野与解剖层面。笔者结合自身上千例腔镜腹股沟疝修补的经验,总结出TAPP方法的七大要素,简称"七步法"。"七步法"通过固定手术场景,将手术简单化,有利于缩短手术学习曲线,推荐临床使用。     

猪小肠黏膜下层脱细胞基质补片在不同术式治疗青壮年腹股沟疝中的应用效果

目的:探讨猪小肠黏膜下层脱细胞基质(SIS)补片用于腹腔镜经腹腹膜前(TAPP)疝修补术与开放无张力疝修补术(Lichtenstein手术)治疗青壮年腹股沟疝临床效果。方法:回顾性分析2015年2月—2018年2月期间首都医科大学附属北京朝阳医院疝和腹壁外科采用SIS补片行疝修补术的268例青壮年腹股沟疝的患者临床资料,其中152例行Lichtenstein手术(Lichtenstein组),116例行TAPP手术(TAPP)。比较两组患者的相关临床指标。结果:Lichtenstein组手术时间、住院费用明显少于TAPP组,但围术期疼痛评分明显高于TAPP组(均P0.05);两组在术中出血量、住院时间方面差异均无统计学意义(均P0.05)。Lichtenstein组术后1周及1、3个月血清肿的发生率均低于TAPP组(均P0.05)。所有患者均未发生异物感、肠梗阻、肠瘘等并发症。结论:SIS补片应用于青壮年腹股沟疝的开放和腹腔镜疝修补术均有确切的效果,但该补片用于两种术式均有各自的优缺点。     

腹腔镜腹膜前疝修补术与Lichtenstein平片疝修补术治疗腹股沟疝的疗效比较

目的:比较腹腔镜腹膜前(TAPP)疝修补术与Lichtenstein平片疝修补术治疗腹股沟疝的临床效果。方法:回顾性收集2013年12月—2015年12月受手术治疗的120例腹股沟疝患者资料,其中53例行腹腔镜TAPP术(TAPP组),67例行Lichtenstein术(Lichtenstein组),分析并比较两组患者的相关临床指标。结果:与Lichtenstein组比较,TAPP组手术时间(52.2 min vs.79.6 min)、术后进食时间(12.2 h vs.20.5 h)、下床活动时间(9.6 h vs.21.8 h)、住院时间(3.9 d vs.6.1 d)均减少(均P0.05);但治疗费用(6 632.7元vs.3 853.7元)增加(P0.05)。两组术中出血量、术后并发症发生率及复发率差异均无统计学意义(均P0.05)。结论:与Lichtenstein术相比,腹腔镜TAPP术治疗腹股沟疝创伤更小,且安全可靠,是临床上较佳的治疗选择之一。     

Comparison of laparoscopic and open tension-free repair of recurrent inguinal hernias: a prospective randomized study

Background The current prospective randomized controlled clinical study aimed to assess the short- and long-term results of recurrent inguinal hernia repair, and to compare the results for transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) procedures with those for open tension-free repair. Methods For this study, 82 patients were randomly assigned to undergo TAPP (group A, n = 24), TEP (group B, n = 26), or open Lichtenstein hernioplasty (group C, n = 32). All the patients with recurrent inguinal hernias had undergone previous repair using conventional open procedures. Physical examination showed Nyhus type II hernia in the vast majority of the patients (59%). High-risk patients (American Society of Anesthesiology [ASA] III or IV); coagulation disorders; previous abdominal or pelvic surgery; and irreducible, congenital, and massive scrotal or sliding hernias were excluded from the study. Results There was a statistically significant difference (p = 0.001) in operating time favoring the open procedure. The intensity of postoperative pain was greater in the open hernia repair group 24 h, 48 h, and 7 days after surgery (p = 0.001), with a greater consumption of pain medication among these patients (p < 0.004). The median time until return to work was 14 days for group A, 13 days for Group g, and 20 days for group C. The comparison was in favor of laparoscopically treated patients. Nine recurrences (4 in the laparoscopic groups and 5 in the open group) were documented within 3 years of follow-up evaluation. Conclusion Laparoscopic inguinal hernia repair (TAPP or TEP) is the method of choice for dealing with recurrent inguinal hernia.     

Long-term results of a randomized clinical trial of Shouldice, Lichtenstein and transabdominal preperitoneal hernia repairs

INTRODUCTION: There is an ongoing debate about the preferred technique for inguinal hernia repair. In this randomized study the long-term results of Shouldice, Lichtenstein and transabdominal preperitoneal (TAPP) hernia repair were compared. METHODS: Some 280 men with a primary hernia were randomized prospectively to undergo Shouldice, tension-free Lichtenstein or laparoscopic TAPP repair. Patients were examined after 52 months to assess hernia recurrence, nerve damage, testicular atrophy and patient satisfaction. RESULTS: Hernia recurrence occurred in six patients after Shouldice repair, and in one patient each after Lichtenstein and TAPP repairs. All recurrences after tension-free repairs were diagnosed within the first year after surgery. Nerve injuries were significantly more frequent after open Shouldice and Lichtenstein repairs. Patient satisfaction was greatest after laparoscopic TAPP repair. CONCLUSION: Tension-free repair was superior to the non-mesh Shouldice technique. The open anterior approach to the groin was associated with demonstrable nerve injury, and laparoscopic TAPP repair was the most effective approach in the hands of an experienced surgeon.     

Laparoscopic repair of inguinal hernias with higher risk for recurrence: independent assessment of results from 121 repairs

This study attempts to determine by independent review the results of laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair for hernias with increased risk for recurrence. Indicators used for increased recurrence risk were recurrent hernias or simultaneously repaired bilateral inguinal hernias. Office and hospital records of all such patients who had undergone TAPP repair were reviewed from one surgeon's 242-patient laparoscopic inguinal hernia database from 1992 to 1998. All were called for assessment by an independent surgeon at least 4 months postoperatively (median 34 months). Those unable to come in person were interviewed by telephone. There were 121 hernias: 34 recurrent and 100 bilateral (13 overlap). Recurrence rate was 3 per cent, which was similar for repair of bilateral and recurrent hernias. All recurrences occurred within 3 months of surgery. No unknown recurrence was detected by the independent observer. Laparoscopic TAPP inguinal hernia repair, often claimed as the method of choice for bilateral and recurrent hernia repair, is indeed a safe and effective procedure with a low early recurrent rate in these higher-risk situations.     

Comparison of Lichtenstein and laparoscopic transabdominal preperitoneal repair of recurrent inguinal hernias

The aim of our study was the comparative analysis of the results of two surgical methods: tension-free repair by the Lichtenstein technique and laparoscopic transabdominal preperitoneal (TAPP) repair. In total 52 patients with recurrent inguinal hernia were randomly assigned to the two groups: Lichtenstein (28 patients) and TAPP (24 patients). Comparisons between these groups were done by several preoperative, intraoperative, and postoperative factors. For postoperative factors both short-term and long-term results were considered. Average operation time for Lichtenstein group was 59.6 +/- 9.9 minutes, compared with 64.4 +/- 8.4 minutes for TAPP patients (P = 0.068). In TAPP patients there was less pain in the postoperative period (P = 0.002) and fewer sick-leave days (13.4 +/- 1.7 versus 17.5 +/- 2.6 days; P < 0.001) and, correspondingly, faster recovery. In the Lichtenstein group a total of 4 postoperative complications (infection, hematoma, seroma, urinary retention) were observed, compared with 8 in the TAPP group (P = 0.19). Statistically significant difference was only by urinary retention (0 for Lichtenstein, 4 for TAPP; P = 0.039). There were no cases of hernia recurrence observed during the followup. Chronic pain developed in 5 patients from the Lichtenstein group (17.9%) and 2 patients from the TAPP group (8.3%; P = 0.28) more than 1 year after the operation; 4 Lichtenstein patients (14.3%) and 1 TAPP patient (4.2%; P = 0.23) more than 2 years after the operation; and 3 Lichtenstein patients (10.7%) and 1 TAPP patient (4.2%; P = 0.36) more than 3 years after the operation. For the treatment of recurrent inguinal hernias, which are developed after use of conventional (nonmesh) methods, the first choice should be given to the laparoscopic method, especially for young, physically active, nonobese patients, and if there are any contraindications for the laparoscopy, the Lichtenstein approach should be recommended.     

Prospective randomized trial of laparoscopic (transabdominal preperitoneal) vs open (mesh) repair for bilateral and recurrent inguinal hernia

Background: Laparoscopic hernia repair excites controversy because its benefits are debatable and critics claim it is attended by serious complications. The one group of patients in whom benefits may outweigh the perceived disadvantages are those with bilateral or recurrent inguinal hernias. Method: One hundred twenty patients with bilateral or recurrent hernias were randomized to either laparoscopic transabdominal preperitoneal (TAPP) or open mesh repair. Patients completed a well-being questionnaire prior to and following surgery together with a visual analog pain score. Patients were followed up clinically at 1 and 3 months and thereafter by their general practitioner. Results: Age and sex distribution was similar in the two groups. Laparoscopic TAPP hernia was quicker (40 vs 55 min; p < 0.001), less painful (visual analog pain score, 2.8 vs 4.3; p = 0.003) and allowed earlier return to work (11 vs 42 days; p < 0.001) compared to open mesh repair. Conclusion: This trial demonstrates that laparoscopic hernia repair via the TAPP route offers significant benefit to patients undergoing bilateral or recurrent inguinal hernia repair.