完全腹膜外腹腔镜腹股沟疝修补术中出血的原因分析及处理

目的 探讨完全腹膜外腹腔镜腹股沟疝修补术(total extraperitoneal,TEP)术中出血的原因及处理.方法 回顾性分析我院2010年10月～2012年12月5例TEP术中出血的临床资料.结果 1例“死亡冠”出血中转开放手术止血,2例腹壁下动脉、1例耻骨梳韧带、1例耻骨后静脉丛出血,均成功腔镜下止血成功完成手术.5例术后3个月随访,疝无复发.结论 TEP术中出血主要是外科医生相对不熟悉腔镜修补腹股沟疝的肌耻骨孔后入路的解剖致误操作所致;手术医生应熟悉解剖,手术发生血管并发症时,应冷静、及时分析原因并正确处理,才能确切止血,保证手术成功.

Analysis of Reasons and Management of Intraoperative Bleeding in Total Extraperitoneal Laparoscopic Inguinal Hernia Repair

Objective To explore the reasons and management of intraoperative bleeding in total extraperitoneal（TEP） laparoscopic inguinal hernia repair.Methods Retrospective analysis of the clinical data of 25 cases from October 2010 to December 2012 was made.Results 1 patient required conversion to open surgery because of corona mortis haemorrhage.Bleeding reasons of other 4 cases included inferior epigastric artery bleeding in 2 cases,pectineal ligament bleeding in 1 case,and retropubic venous plexus bleeding in 1 case.Laparoscopic hemostasis was completed successfully in the 4 cases.A 3-month follow-up of the 5 cases showed no recurrence of hernia.Conclusions Intraoperative bleeding is caused mainly by surgeons＇ unfamiliarity with the anatomy of the groin area.Surgeons should be familiar with the anatomy,remain composed and take timely and proper measures to ensure the success of operation when complications occur.