完全腹膜化腹腔镜腹腔内补片植入法治疗成人腹股沟嵌顿性斜疝

目的:探讨完全腹膜化腹腔镜腹腔内补片植入法治疗成人腹股沟嵌顿性斜疝的安全性、可行性及优越性。方法:2002年1月至2007年6月,我院应用腹腔镜腹腔内补片植入术联合脐正中襞完全覆盖网片法治疗成人急性腹股沟嵌顿性斜疝患者35例。结果:5例麻醉后自动复位,25例腹腔镜手法复位或辅助复位成功,4例镜下剪开内环口复位成功,1例经腹股沟区小斜切口切开部分弓状下缘复位成功。35例均行腹腔镜腹腔内补片植入术联合脐正中襞完全覆盖网片法,5例附加肠切除吻合术,1例大网膜切除术。平均手术时间55(30～110)min,平均住院6.5(3～11)d。无切口感染、肠梗阻等并发症发生,术后3dB超检查未见腹腔、盆腔积液等并发症。随访6～48个月,平均26个月,无复发、粘连性肠梗阻、睾丸萎缩等。结论:完全腹膜化腹腔镜腹腔内补片植入法治疗成人急性腹股沟嵌顿性斜疝安全、可行、有效,具有创伤少、并发症少、费用低等优点。

Fully peritonealized laparoscopic intraperitoneal onlay mesh in adult patients with incarcerated indirect inguinal hernia

Objective:To investigate the safety,feasibility and advantage of laparoscopic repair for incarcerated indirect inguinal hernia in adults using fully peritonealized intraperitoneal onlay mesh technique.Methods:From Jan. 2002 to Jun. 2007,35 adult patients with acute incarcerated indirect hernia were performed laparoscopic intraperitoneal onlay mesh and peritonization with the median umbilical fold.Results:Four cases were reposited by themselves after anesthesia,25 cases were reposited by manual or laparoscopic assist,4 cases were reposited by laparoscopic cutting internal ring,and one case was reposited by cutting the partial arcade inferior border through small oblique incision in inguinal region.All 35 cases were performed laparoscopic intraperitoneal onlay mesh combined with complete cover of mesh by the median umbilical fold,five patients received the laparoscopic assisted small bowel resection and anastomosis,and one patient accepted laparoscopic assisted omentum resection.Mean operative time was 55min (30-110min) and mean hospital stay was 6.5days (3-11 days).There were no complications such as incision infection,ileus,and no abdominal and pelvic dropsy were discovered by B mode ultrasonography on the third day after surgery.During a follow-up period of 6 to 48 months (mean 26 months),there was no recurrence,adhesive intestinal obstruction and atrophy of testis.Conclusions:Fully peritonealized laparoscopic intraperitoneal onlay mesh is a safe,feasible and effective procedure for incarcerated indirect hernia in adults,with the advantages of less trauma,complications and cost.