腹腔镜下腔隙韧带切开术治疗嵌顿股疝的临床观察

目的探讨腹腔镜下腔隙韧带切开术治疗嵌顿股疝的临床疗效。方法回顾性分析我院2010年3月~2018年3月腹腔镜下腔隙韧带切开术治疗嵌顿性股疝患者的临床资料。结果 23例嵌顿股疝患者行腹腔镜下腔隙韧带切开术治疗(TAPP术式),其中男5例,女18例。术中无肠管副损伤,无因复位不了嵌顿内容物而中转开腹,但有4例患者肠坏死中转开腹行肠切除术。1例患者因术中损伤膀胱于腔镜下修补。手术时间50~180 min(平均103.36±52.87 min),出血量2~50 mL(平均13.7±10.2 mL),住院时间3~15 d(平均5.80±3.25 d)。术后15例皮下气肿,7例血清肿,1例患者伤口感染经换药治愈,1例患者术后粘连性肠梗阻保守治疗好转。随访1个月至48个月,无复发,无补片感染。结论腹腔镜下腔隙韧带切开术治疗嵌顿性股疝可以有效避免肠管副损伤,降低开腹中转率。

The clinical observation on the treatment of incarcerated femoral hernia by laparoscopic incisional lacunare ligamentum procedure

［Abstract］ Objective To investigate the clinical effect of laparoscopic incising lacunare ligament in the treatment of incarcerated femoral hernia. Methods The clinical data of patients with incarcerated femoral hernia were retrospectively analyzed in our hospital from March 2010 to March 2018. Results Twenty-three patients（5 males，18 females） with incarcerated femoral hernia underwent laparoscopic lacunare ligament dissection treatment （TAPP operation）. There was no transfer to laparotomy because the incarcerated contents could not be reset. Four cases of patients with intestinal necrosis were subjected to bowel resection, and one case with bladder injury underwent laparoscopic suture. The operation time ranged from 50 to 180 min（103.36±52.87）, the bleeding was 2?50 ml（13.7±10.2），and the length of hospital stay was 3 to 15 days （mean 5.80 ± 3.25）. The post-subcutaneous emphysema and seroma occurred in 15 and 7 cases respectively were cured by conservative treatment, and one case of wound infection was cured by dressing change. Postoperative adhesion intestinal obstruction occurred in one patient and got recovery after conservative treatment. All 23 cases were followed up for 1 to 48 months. No recurrence, patch infection were found. Conclusion The surgical procedure treated incarcerated femoral hernia by laparoscopic incising lacunare ligament can effectively avoid the secondary injury of the bowel and reduce the rate of laparotomy.