腹腔镜下疝内容物复位加疝环充填式无张力疝修补术治疗成人腹股沟嵌顿疝的临床应用

目的探讨腹腔镜下疝内容物复位加疝环充填式无张力疝修补术治疗成人腹股沟嵌顿疝的可行性及临床价值。方法回顾性分析我院2012年6月至2016年6月应用腹腔镜下疝内容物复位加疝环充填式无张力疝修补术治疗46例嵌顿性腹股沟疝患者的临床资料。结果全麻后有11例疝内容物自行回纳,腹腔镜下探查疝内容物均为小肠,其中1例小肠坏死,行部分小肠切除术。余35例患者成功行腹腔镜下疝内容物复位,其中2例大网膜坏死行部分大网膜切除术。所有患者腹腔渗出液WBC为1.32×10~9/L~78.81×10~9/L,平均(25.34±11.03)×10~9/L,疝囊周围渗液WBC为0.18×10~9/L~2.31×10~9/L,平均(0.42±0.28)×10~9/L。所有患者疝囊外周渗液涂片未找到脓细胞。术中腹腔镜探查发现合并对侧隐匿疝(斜疝)5例,予行疝环缝扎术,脂肪肝7例,肝囊肿14例,空肠憩室1例。全部病例顺利行疝环充填式无张力疝修补术。手术时间75~110 min,平均87.4 min。住院时间5~7 d,平均6.7 d。术后肠功能恢复时间15~36 h,平均20.4 h。术后5例出现血清肿、3例出现暂时性神经感觉异常。1例出现腹股沟区伤口脂肪液化坏死,加强伤口消毒、换药后伤口逐渐愈合。余病例无并发症。随访时间4个月至40个月,平均22.8个月,无术后疝复发。结论腹腔镜下疝内容物复位加疝环充填式无张力疝修补术治疗腹股沟嵌顿疝具有探查全面、及时复位、一期修补的优点,安全可行。

Clinical application of laparoscopic reduction and plug-mesh tension-free hernia repair in treat-ment of adult incarcerated inguinal hernia

【Abstract】 Objective To investigate the feasibility and clinical value of laparoscopic reduction and plug?mesh tension?free hernia repair in treatment of adult incarcerated inguinal hernia. Methods The clinical data of 46 patients with adult incarcerated inguinal hernia, who underwent laparoscopic reduction and plug?mesh tension?free hernia repair between June 2012 and June 2016，were analyzed retrospectively. Results Spontaneous reduction was occurred during the procedure of general anaesthesia in 11 patients and incarcerated small bowels were detected during laparoscopic examination. Strangulated small bowels were found in one patient who underwent enterectomy. The incarcerated tissues were reduced laparoscopically in the other 35 patients and strangulated omentum was found in two patients. The blood white cell count of peritoneal effusion ranged from 1.32×109/L to 78.81×109/L，（mean，25.34±11.03 ×109/L），while the count of extrasac effusion were from 0.18×109/L to 2.31×109/L，（mean，0.42±0.28 ×109/L）. The pus cells were not found in effusion of hernia sac. An incident finding of contralateraloccult indirect hernia was also noted during laparoscopic exploration in 5 cases who underwent ligation of hernia ring，and fatty liver in seven cases，hepatic cyst in 14 cases，diverticulum of jejunum in one case，respectively. All patients underwent plug ? mesh tension ? free hernia repair successfully. The operation time ranged from 75 minutes to 110 minutes with a mean of 87.4 minutes. The hospital stay was 5 to 7 days with a mean of 6.7 days. The function of the bowel recovered in 15~36 hours with a mean of 20.4 hours. The postoperative seroma was found in 5 patients，transient paresthesia in 3 patients，and fat liquefaction of incisions in 1 patient who was cured by strengthening the wound disinfection. There were no complications in other patients. The follow?up periods arranged from 4 months to 36 months（mean， 22.8 months）. All of the patients had no recurrent hernias. Conclusion The procedure of laparoscopic reduction and plug?mesh tension?free hernia repair in treatment of adult incarcerated inguinal hernia has the advantage of complete exploration，timely reduction，spontaneous repair，safety and feasibility.