我国腹腔镜腹股沟疝修补术的应用现状与展望

腹腔镜技术用于治疗腹股沟疝始于20世纪90年代初期,经过近20年的改进,腹腔镜腹股沟疝修补术(laparoscopic inguinal hernia repair,LIHR)已趋于成熟,疗效满意,与开放手术相比具有明显优势。但因技术、设备、材料、麻醉方式、医疗费用等问题,腹腔镜疝修补术仍未成为治疗腹股沟疝的金标准,学术界对普及LIHR仍意见不一。现将LIHR的应用现状和发展前景做一综述。     

腹腔镜腹股沟疝修补术

腹腔镜腹股沟疝修补术是一新术式。本文介绍主要术式的操作步骤，并评价各术式的优缺点，虽然目前的经验和结果还不成熟，但值得进一步研究。     

腹腔镜腹股沟疝修补术

腹腔镜腹股沟疝修补术成都军区昆明总医院外科（６５００３２）陈训如，罗丁新加坡中央医院外科ＰｅｔｅｒＭａｃｋ传统协的手术治疗包括沈囊高位结扎、切除血囊和沈修补术。但由于上述操作需作腹股沟区广泛解剖分离，可能引起精索血管损伤和辜丸萎缩，腹股沟管的过度缩窄...     

腹腔镜腹股沟疝修补术常规

腹腔镜腹股沟疝修补术是一种安全、技术合理的无张力修补手术。腹腔镜腹股沟疝修补术适用于Ⅰ型、Ⅱ型、Ⅲ型和IV型的腹股沟直疝、斜疝和股疝(中华外科学会疝与腹壁外科学组2003年8月修订稿)。腹腔镜腹股沟疝修补术主要包括两种方法:经腹腹膜前补片植入术(TAPP),全腹膜外补片植     

腹腔镜腹股沟疝修补术的应用

腹腔镜腹股沟疝修补术(laparoscopic inguinal hernia repair,LIHR)始于上世纪90年代初,经过10多年的发展,目前技术已较为成熟,其合理性也已得到证实[1].但国内起步较晚,有些医师对LIHR的修补层次和操作特点不甚了解,盲目的选择病例、术中操作不规范或进行各种所谓的"改良",往往引起不良的后果,数次后失去信心放弃手术,非常可惜.本文结合文献及自身的临床经验,就LIHR的手术方法、术式选择和操作要点作一探讨.     

腹腔镜腹股沟疝修补术80例

目的总结腹腔镜腹股沟疝修补术的临床效果与价值。方法采集2011年1月至2014年10月,云南省西双版纳州医院收治的腹股沟疝患者80例,随机分为经腹腹膜前疝修补术(TAPP)组和完全腹膜外疝修补术(TEP)组,每组患者40例。对二组患者的手术时间、住院时间、并发症等临床资料进行回顾性分析。结果本组80例患者手术顺利,无中转开放手术。TAPP组平均手术时间(45.0±5.0)min,TEP组平均手术时间(45.0±3.0)min,二组比较差异无统计学意义(t=11.14,P=0.153)。TAPP组平均住院时间(3±1)d,TEP组平均住院时间(3±1)d,二组比较差异无统计学意义(t=15.25,P=0.128)。TAPP组患者发生阴囊血肿2例,TEP组发生阴囊血肿2例,差异无统计学意义(χ2=6.85,P=0.087)。TAPP组尿潴留5例,TEP组尿潴留2例,二组比较差异有统计学意义(χ2=13.10,P=0.000)。TAPP组腹股沟区疼痛2例,2周后自行消失;TEP组无疼痛患者,二组比较差异有统计学意义(χ2=8.15,P=0.000)。随访3~18个月,平均(6±2)个月,无复发。结论腹腔镜腹股沟疝修补术手术时间短,住院时间短,并发症少,复发率低,患者疼痛轻。且在手术过程中能同时发现隐匿性疝,避免患者2次手术,适用于腹股沟疝的治疗。     

腹膜外腹腔镜腹股沟疝修补术

<正> 腹腔镜腹股沟疝修补术因经腹而引起争议。腹腔镜疝修补术因腹壁损伤小,术后恢复快而被许多学者接受,但手术费用高,需要应用人工修补材料及特殊腹腔镜手术器械,术后30％的患者出现神经痛和股部感觉异常,1％的患者出现肠梗阻和1％—10％术后复发率,该术式没有象腹腔镜胆囊切除术广泛开展。为降低腹腔镜腹股沟疝修补术术后复发率,减少术后肠梗阻、神经痛和股部感觉异常的发生,开始采用腹膜外腹腔镜腹股沟疝修补术,2例男性腹股沟疝患者行修补术,近期效果满意,报告如下。     

腹腔镜腹股沟疝修补术300例

目的 评价腹腔镜腹股沟疝修补术的安全性和有效性.方法 2005年3月～2010年3月行腹腔镜腹股沟疝修补术300例(357侧),其中TAPP 221例(273侧),TEP 79例(84侧).TAPP:建立气腹后打开腹膜,回纳疝囊,分离出腹膜前间隙,置入补片后钉合器固定,关闭腹膜.TEP:在腹膜前钝性建立足够间隙,回纳...     

腹腔镜腹股沟疝修补术技术评估

腹股沟疝是常见病,且在男性人群中发病率较高,手术修补则是惟一的治愈方式。腹腔镜腹股沟疝修补术（laparoscopic hernia repair）在1982年首先由Ger报道。外科医师在开展初期对多种术式进行尝试,经过10余年的发展,目前临床上采用的有以下4种方法：内环扣关闭术、     

Factors associated with laparoscopic approach for cholecystectomy, appendicectomy and inguinal herniorraphy in France

OBJECTIVE: To determine on a national level the factors associated with the use of laparoscopy for digestive surgery. STUDY DESIGN: Nation wide study using a large representative sample (3 days of anaesthesia in France). METHODS: Univariate followed by multivariate analyses of data gathered in 1996 during the survey led by the French Society of Anaesthesia and Intensive care ("SFAR") including 2847 surgical procedures for cholecystectomy, appendicectomy or inguinal herniorraphy. RESULTS: Independent factors associated with the use of laparoscopy were: for cholecystectomy: age (less frequent when > or =71 years: adjusted Odds ratio [AOR] 0.4), sex (more frequent in female: AOR 1.7), ASA physical status (less frequent when > or =3: AOR 0.5), private hospital (AOR 2.0), procedure scheduled at least the night before (AOR 2.1), and use of closed circuit general anaesthesia (AOR 1.6); for appendectomy: age >15 years (AOR 1.9-2.2), female (AOR 2.1), private hospital (AOR 2.7), scheduled procedure (AOR 2.1), prolonged procedure (AOR 8.4), endotracheal intubation (AOR 16.7), and closed circuit (AOR 2.7); for inguinal herniorraphy: ASA physical status (less frequent when > or =3: AOR 0.4), private hospital (AOR 3.4), prolonged procedure (AOR 5.6), and endotracheal intubation (AOR 21.6). Association with a closed circuit was confirmed for general anaesthesia using a volatile agent (AOR 1.5). Overall, ambulatory surgery was rarely performed and used only for open procedures. Regional anaesthesia was used only for inguinal open herniorraphy. CONCLUSION: These data obtained from a large national survey confirmed the higher frequency of laparoscopy in middle aged patients, female (except for inguinal herniorraphy), without important comorbidity, in private hospitals. Laparoscopy was associated with prolonged procedures and with a change in the anaesthetic technique for appendicectomy and inguinal herniorraphy: tracheal intubation was almost constantly used. Whatever the procedure, closed circuit anaesthesia was more frequently used when surgery was performed under laparoscopy, reflecting newer equipment of the hospital, private or public.     

Day case laparoscopic herniorraphy

Background The aim of this study was to evaluate day case laparoscopic herniorraphy (LH) and to ascertain the impact of trainee surgeons on its performance. Methods We performed a prospective study of ambulatory laparoscopic transabdominal preperitoneal herniorraphies performed in a dedicated day surgical unit between March 1996 and October 2003. Results A total of 840 herniorraphies were performed in 706 consecutive patients. Surgery was performed by 15 higher surgical trainees and three consultant surgeons. The mean operating times for trainees were longer for unilateral (48.4 ± 0.98 vs 41.4 ± 0.87 min, p < 0.05) and bilateral (69.0 ± 3.24 vs 53.0 ± 1.68 min, p < 0.05) repairs than for consultants. Subgroup analysis demonstrated that after an experience of 40 procedures, trainee times approached those of the consultants (41.39 ± 1.17 vs 41.4 ± 0.87 min, p= 0.31). LH repair was well tolerated and associated with minimal postoperative pain and nausea. Mean pain scores postoperatively and at 24 h were 2.69 ± 0.11 and 2.07 ± 0.09, respectively. Mean nausea scores postoperatively and at 24 h were 0.34 ± 0.06 and 0.22 ± 0.06, respectively. Ninety-three percent of patients (n = 657) were discharged within 8 h. There were two conversions to an open procedure (0.1%) and two significant complications (0.1%). Ninety-five percent of patients who responded to our questionnaire (n = 398/419) were satisfied with surgery and would undergo day case laparoscopic herniorraphy again. Conclusions Laparoscopic herniorraphy is a safe technique suitable for day case surgery. Operator experience dictates duration of surgery. Trainees’ operating times approach those of consultants after 40 procedures. Prolonged operating times and increased cost are not justifiable reasons for not recommending LH.     

Torsion of testicle after inguinal herniorraphy

Testicular torsion occurring ten years after bilateral inguinal herniorraphy is described herein. The assumption that operative inguinal manipulation confers prophylaxis against the development of torsion is misleading and should not interfere with the workup of an acute condition of the scrotum.     

单孔腹腔镜手术的现状与前景

在确保治疗安全性和有效性的前提下,尽可能减少手术创伤是所有外科医生的追求,也是外科学的发展方向.经自然孔道内镜外科(natural orifice transluminal endoscopic surgery,NOTES)正是在这样的背景下应运而生的,其优势在于减少或隐藏手术瘢痕,减轻术后疼痛,促进术后康复等[1-3].     

Potential benefits of single-port compared to multiport laparoscopic inguinal herniorraphy: a prospective randomized controlled study

Background

Multiple prospective studies have confirmed safety and efficacy of laparoscopic inguinal herniorraphy with single-port compared to multiport surgery. This prospective randomized controlled trial aimed to assess safety, efficacy and potential benefits of single-port total extraperitoneal inguinal herniorraphy beyond the learning curve.

Methods

All referred patients with inguinal/femoral hernias were enrolled from December 2011 to February 2013. Exclusion criteria included workers compensation cases. Identical balloon dissector, light-weight mesh and non-absorbable tacks were used in all cases. For single-port cases Triport? was used while structural balloon trocar/inflation bulb for multiport cases. Results were analyzed with IBM^® SPSS^® version 22 for Windows.

Results

Participation rate was 100 % with 157 inguinal/femoral hernias in 100 patients: 51 randomized to single-port and 49 to multiport group. There was no conversion to open surgery/need for additional ports. There were no statistical differences between single-port and multiport groups with respect to age, sex, body mass index, American Society of Anesthesiologists scores, preoperative pain, hernia defect sizes and length of hospital stay. Operation times were equivalent for single-port and multiport 60.0 vs 61.0 min, P = 0.23, respectively. Significantly, single-port patients ingested fewer pain killers: 6 tablets vs 14 Dextropropoxyphene tablets, P < 0.001, experienced less pain (visual analog scores) on day 1 and 7 post-op op: 2.5 and 0, P < 0.001 compared to 4.5 and 2.5, P < 0.001, respectively, returned to work/normal physical activities 7 days quicker: 7.0 vs 14.0, P < 0.001 and had higher cosmetic scar scores at 6-week follow-up: 24 vs 21, P < 0.001, compared to multiport patients. There were no mortalities, morbidities or recurrences after follow-up of 6–21 months.

Conclusions

Compared to multiport, single-port laparoscopic total extraperitoneal inguinal herniorraphy, when performed by a high-volume and highly dedicated hernia surgeon, resulted in significantly reduced postoperative pain, analgesic requirements, quicker return to work/normal activities, improved cosmesis, and equivalent safety and efficacy.