采用腹直肌后鞘后方路径行完全腹膜外腹腔镜腹股沟疝修补术的临床应用

目的:探讨采用腹直肌后鞘后方路径行腹腔镜完全腹膜外疝修补术(totally extraperitoneal,TEP)的特点、手术技巧及临床经验。方法:回顾分析2010年8月至2012年12月为98例腹股沟疝患者采用腹直肌后鞘后方路径行TEP的临床资料,其中腹股沟斜疝89例、直疝9例;双侧疝9例,单侧疝89例。结果:98例手术均顺利完成,无一例中转开腹;手术时间25¹10 min,单侧平均(42±3.5)min,双侧平均(63±5.6)min。术后住院2110 min,单侧平均(42±3.5)min,双侧平均(63±5.6)min。术后住院2⁵ d,平均(3±0.5)d。术后并发气腹腹胀、阴囊气肿11例,阴囊血肿1例。随访65 d,平均(3±0.5)d。术后并发气腹腹胀、阴囊气肿11例,阴囊血肿1例。随访6¹8个月,无一例复发。结论:采用腹直肌后鞘后方路径行TEP,可直接进入腹膜外间隙,充分游离疝囊、精索后,利用补片边缘的可塑性,通过一小片补片重叠缝合,使精索牢靠地嵌入补片内,达到了固定补片的目的,无需钉合;手术简单快捷,容易推广。

Clinical application of totally extraperitoneal laparoscopic inguinal hernia repair in posterior sheath of the rectus muscles pos- terior approach

Objective：To explore the operation characteristics, operation techniques and clinical experience ol laparoscopm to- tally extraperitoneal （TEP） prosthesis in posterior sheath of the rectus muscles posterior approach. Methods：Clinical data of 98 pa- tients （89 indirect inguinal hernia,9 direct hernia ;9 bilateral hernia,89 unilateral hernia） who underwent laparoscopic TEP repair from Aug. 2010 to Dec. 2012 were retrospectively analyzed. Results：All 98 operations were successfully performed without conversion to open surgery. The mean operation time was 25-110 rain. The time for unilateral hernia was （42 ＋-3.5 ） rain and bilateral hernia was （63 ＋ 5.6） rain. The postoperative hospital stay time was 2-5 d ,with an average of （3 ＋-0.5 ） d. The abdominal distension and subcutaneous emphysema of scrotum was observed in 11 patients after operation and hematoma of scrotum appeared in 1 patient. The patients were fol- lowed up for 6-18 months and no recurrence occurred. Conclusions ：The TEP operation in posterior sheath of the rectus muscles posteri- or approach can directly access the extraperitoneal space, completely separate hernia sac and spermatie cord, utilize the plasticity of the mesh edge, overlap and suture a little piece of mesh, make the spermatie cord firmly implanted in the mesh to fix it. This procedure is a simple, fast and easily generalized treatment for hernia without stapling.