腹腔镜前列腺癌根治术后腹股沟疝13例诊治分析

目的 比较不同路径的前列腺癌根治术腹股沟疝发病率,探讨腹腔镜无张力疝修补术治疗前列腺癌根治术后腹股沟疝的临床疗效和安全性。 方法 回顾性分析2007年11月-2014年7月泌尿外科收治的行腹腔镜下前列腺癌根治术的患者312例,其中223例行经腹腔路径手术,89例行经腹膜前路径手术,术后随访3个月~2年,观察有无腹股沟疝的发生。若在随访期内发生腹股沟疝,预约患者返院以行腹腔镜下腹股沟疝无张力修补术。记录手术时间、引流管引流时间、住院时间以及所有的围手术期并发症,并对患者进行为期1年的随访,以观察有无腹股沟疝的复发。 结果 经腹膜前路径、经腹腔路径的前列腺癌根治患者分别有3例、10例腹股沟疝发生。经腹腔路径中,实施双侧淋巴结清扫、未实施双侧淋巴结清扫的分别有8例、2例腹股沟疝发生;13例发生腹股沟疝的患者均接受腹腔镜下无张力补片修补术,平均手术时间28 min(15~50 min),术中无输血、中转开放手术病例。术后未出现并发症,腹腔引流管留置1~3 d,平均住院时间5 d(3~7 d)。术后随访1~12个月,平均10个月,未见腹股沟疝复发。 结论 腹股沟疝是腹腔镜前列腺癌根治术重要的并发症之一,根治手术的入路、是否行双侧淋巴结清扫并非是腹股沟疝发生的影响因素;腹腔镜下疝无张力修补术是治疗术后腹股沟疝的一种安全有效的微创治疗方法,远期疗效有待进一步随访观察。 

Clinical study of 13 cases of laparoscopic tension-free hernia repair of inguinal hernia after radical prostate ctomy

Objective To compare the incidence of inguinal hernia in patients undergoing laparoscopic radical prostatectomy via different approach,and investigate the safety and efficiency of laparoscopic tension-free hernia repair for inguinal hernia after radical prostatectomy. Methods Clinical data was collected retrospectively for 312 patients received laparoscopic radical prostatectomy from November,2007 to July,2014,including 223 intraperitoneal and 89 extraperitoneal (preperitoneal) radical prostatectomy.All patients were followed up from 3 months to 2 years.If inguinal hernia occurred in the follow-up period,the patients were invited to return to the hospital for laparoscopic tension-free hernia repair.The operative duration,drainage time,hospitalization days and all perioperative complications were documented.All patients were followed up for one year,in order to observe the recurrence of inguinal hernia. Results The inguinal hernia of intraperitoneal and preperitoneal prostatectomy were 10 cases and 3 case,respectively.For intraperitoneal approach,there were 8 cases of inguinal hernia in bilateral lymphadenectomy and 2 cases in patients without bilateral lymphadenectomy.All patients of inguinal hernia underwent laparoscopic tension-free hernia repair.The mean operative time was 28 min (15 to 50 min).There was no intraoperative blood transfusion,conversion to open surgery cases or postoperative complications.Peritoneal drainage tube lasted 1-3 d,and the average hospital stay was 5 d (3 to 7 d).The patients were followed up 1-12 months with an average of 10 months,and no recurrent inguinal hernia was found. Conclusion Inguinal hernia is one of the major complications of laparoscopic radical prostatectomy.Laparoscopic approach and bilateral inguinal lymph node dissection are not influence factors of hernia;laparoscopic hernia tension repair is a safe and effective minimally invasive treatment for inguinal hernia surgery.Long-term efficacy remains to be seen for longer follow-up.