透壁缝合法处理直疝假性疝囊预防术后血清肿应用研究

目的探讨在腹腔镜腹股沟疝修补术中使用透壁缝合法处理腹股沟直疝假性疝囊预防术后血清肿的效果。 方法广州市番禺区何贤纪念医院肝胆疝外科自2017年1月1日至2018年6月30日手术治疗的74例直疝患者，其中Ⅰ型疝12例、Ⅱ型37例、Ⅲ型25例，62例Ⅱ型及Ⅲ型患者术中行透壁缝合法处理直疝假性疝囊。 结果74例患者均在腹腔镜下顺利完成腹股沟直疝无张力修补术。Ⅰ型疝手术时间为（38.42±2.81）min，出血量为（4.42±2.31）ml，术后1 d视觉模拟评分（VAS）（2.83±1.19）分，7 d VAS（1.00±0.85）分；Ⅱ型手术时间为（44.49±3.25）min，出血量为（7.00±1.75）ml，术后1 d VAS（2.84±1.21）分，7 d VAS（1.08±0.83）分；Ⅲ型手术时间为（50.64±3.35）min，出血量为（5.92±2.60）ml，1 d VAS（2.84±1.18）分，7 d VAS（0.92±0.86）分。术后随访期无血清肿发生、无睾丸肿胀疼痛、无性生活障碍、无疝复发及腹股沟区慢性疼痛出现。 结论腹腔镜腹股沟疝修补术中透壁缝合法处理直疝假性疝囊对于预防术后血清肿是一种安全、有效、可靠的技术，不增加术后疝复发率及慢性疼痛，值得临床进一步研究。

Transadominal suture technique in closing pseudohernia sac of direct hernia for seroma prevention after laparoscopic direct inguinal hernia repair

ObjectiveTo investigate the efficacy of transadominal suture technique with a needle forcep in close of the pseudohernia sac of direct hernia for the prevention of seroma formation under laparoscopic direct inguinal hernia repair. Methods74 patients with direct hernia (12 cases of type Ⅰ, 37 cases of type Ⅱ, 25 cases of type Ⅲ) were treated surgically fom January 1, 2017 to June 30, 2018. The pseudohernia sac was managed by transadominal suture technique in 62 cases of type II and type III during operation. ResultsAll patients underwent surgery successfully. For type I hernia, the operation time was (38.42±2.81) minutes, the bleeding volume was (4.42±2.31) ml, the postoperative pain score was (2.83±1.19) at 1^st day, and (1.00±0.85) at 7^th day; For type Ⅱ, (44.49±3.25) minutes, (7.00±1.75) ml, (2.84±1.21) at 1^st day, and (1.08±0.83) at 7^th day; For type Ⅲ, (50.64±3.35) minutes, (5.92±2.60) ml, (2.84±1.18) at 1^st day, and (0.92±0.86) at 7^th day. There was no seroma formation, testicular swelling and pain, sexual disturbanceand, hernia recurrence and chornic groin pain after operation and during follow-up. ConclusionThe management of pseudohernia sac of direct hernia with transadominal suture technique during laparoscopic direct inguinal hernia repair is safe, efficient and reliable for prevention of post-operative seroma formation, without increasing hernia recurrence and the risk of developing chronic groin pain, which is worth of being generalized.