腹腔镜腹股沟疝修补手术方式选择与手术经验

目的总结我院腹腔镜腹股沟疝修补手术经验，探讨腹腔镜腹股沟疝修补手术方式的选择及手术经验技巧。方法回顾分析我中心2002年10月至2006年12月收治的212例行腹腔镜腹股沟疝修补术的资料，其中腹腔内补片覆盖法18例，经腹腔腹膜前修补法20例，完全腹膜外疝修补法174例，年龄18～91岁，平均53岁，随访时间1～50个月。结果IPOM术后出现粘连性肠梗阻症状2例，复发2例，膀胱损伤1例；TAPP术后出现粘连性肠梗阻症状1例、腹股沟区疼痛1例；TEP术后主要并发症为阴囊血清肿或血肿，共18例（10．34％）；术后腹股沟区疼痛4例，膀胱损伤1例，复发1例。TEP手术并发症多为早期开展的手术病例。结论TAPP和TEP手术安全可靠，复发率低，在各种腹腔镜疝修补术中TEP手术优点更明显，应成为腹腔镜治疗腹股沟疝的首选术式。

The procedure choice and operation experiences of laparoscopic ingunal hernia repair

Objective To study the success experience of laparoscopic inguinal herniorrhaphy,operation skills and choice of operation method.Methods Two hundred and twelve patients with inguinal hernia treated by laparoscopic hernia repair from Oct.2002 to Jan.2006 were retrospectively analyzed,in which 18 patients treated by intraperitoneal onlay mesh(IPOM),20 patients by transabdominal preperitoneal hernia repair(TAPP) and 174 by totally extraperitoneal hernia repairs(TEP). The patients' mean age was 53 years (ranged from 18 years to 91 years).The follow-up lasted for 1-50 months.Results Two patients had the symptoms of adhensive intestinal obstruction,2 cases recurred and 1 case suffered bladder injury in the IPOM group.One patient had the symptoms of adhensive intestinal obstruction after TAPP and 1 case appeared inguinal pain.In TEP group,the mostly complications were hematomas or seromas,accounted for 18 cases(10.34%),4 cases appeared inguinal pain,only 1 patient recurred,and the complications occurred in the cases at the early stage of the operation.Conclusion The procedures of TEP and TAPP are safe and credible,with lower complications and recurrence rate.Compared with the IPOM and TAPP,TEP should be the best laparoscopic procedure for inguinal hernia repair because of its obvious advantages.