完全腹膜外腹腔镜疝修补术在下腹部手术史病人中的可行性研究

目的探索完全腹膜外腹腔镜疝修补术（TEP）在下腹部手术史病人中的可行性。 方法收集2018年1-12月收治的387例接受TEP治疗的择期腹股沟疝病人临床资料，选取有相关下腹部手术史病人64例，分析病人的围手术期情况及术后随访情况。 结果选取64例病人，男53例，女11例，手术时间（50.05±19.28）min，出血量（7.27±5.64）mL。64例中60例病人顺利完成TEP，3例病人中转为开放手术，1例病人中转为经腹腹腔镜下腹膜前疝修补术，4例中转病例均有前列腺癌手术史。病人术后住院时间（1.17±0.68）d，发生血清肿病人1例，脐部切口感染1例，尿潴留5例，无慢性疼痛、补片感染、肠粘连、复发等并发症。 结论大多数有下腹部手术史的腹股沟疝病人选择TEP治疗是安全、可行的。术者术前需要详细评估既往手术对解剖层面和手术视野的影响，熟练掌握腹股沟区解剖和运用腹腔镜技术。

Feasibile study of laparoscopic totally extra-peritoneal in patients with a history of lower abdominal surgery

ObjectiveTo explore the feasibility of laparoscopic totally extra-peritoneal(TEP)in patients with a history of lower abdominal surgery. MethodsAmong 387 patients scheduled by TEP from January 2018 to December 2018, 64 patients with a history of lower abdominal surgery were selected, and the perioperative situation and postoperative following-up were analyzed. ResultsSixty-four patients(53 males and 11 females)were selected, the operative time and intraoperative blood loss were(50.05±19.28)min and(7.27±5.64)mL, respectively.The TEP in 60 cases were successfully completed.Three cases were converted to open repair, 1 case was converted to laparoscopic trans-abdominal preperitoneal hernia repair, and the 4 cases had a history of prostate cancer.The postoperative hospitalization duration of patients was(1.17±0.68)d, 1 case of seroma, 1 case of umbilical cord incision infection and 5 cases of urinary retention were identified.No chronic pain, patch infection, intestinal adhesion and recurrence in all cases were found. ConclusionsTEP is safe and feasible for the majority of inguinal hernia patients with a historyof lower abdominal surgery.Before surgery, the surgeon should carefully evaluate the impact of previous surgery on the anatomical level and surgical field, and master the anatomy of the inguinal region and application of laparoscopy.