腹腔镜腹股沟疝修补术后血清肿诊疗策略

摘要

Objective To investigate the classification,prevention and treatment of seroma after laparoscopic inguinal hernia transabdominal preperitoneal repair (TAPP).Methods The clinical data of 340 patients undergoing TAPP treated from January 2010 to May 2015 were retrospectively analyzed.The incidence of seroma after TAPP was observed,and the management and prognosis of seroma were analyzed.Results There were 46 cases of postoperative seroma,accounting for 13.5%.There were 7 cases of type Ⅰ,30 cases of type II,6 cases of type Ⅲ,and 3 cases of type Ⅳ.Most patients with mild clinical symptoms were given physical therapy and traditional Chinese medicine.The patients with moderate and serious clinical symptoms were treated by puncture drainage.The seroma lasted more than 5 months in 2 cases,and was given the repeated puncture drainage.The seroma was found one month postoperation in one case,and no obvious discomfort occurred.One year later,the hernia recurred,and open tension-free hernia repair was done.Conclusions With a unified classification of post-operative seroma,it is possible to make a more accurate understanding of the incidence and severity of postoperative seroma after TAPP,and benefit to evaluate the effective methods to reduce the formation of seroma.It suggests that exquisite operation and individualized treatment can prevent seroma.%目的 探讨腹腔镜经腹腹膜前腹股沟疝修补术后血清肿的分型及预防、治疗措施.方法 回顾性分析中国人民解放军武汉总医院2010年1月至2015年5月采用腹腔镜经腹腹膜前腹股沟疝修补术治疗的340例病人临床资料,观察术后血清肿发生情况及临床表现,以及临床治疗效果.结果 术后血清肿共46例,占13.5%.Ⅰ型7例,Ⅱ型30例,Ⅲ型6例,Ⅳ型3例,轻微病人多数给予理疗及中药外敷缓解;较重病人给予穿刺抽液多可缓解;2例病人血清肿持续逾5月余,给予反复穿刺抽液后缓解;1例病人术后1个月复查发现血清肿,但无明显疼痛不适,1年后复查疝复发,予以开放无张力疝修补术痊愈.结论 统一的血清肿分型可以让我们更准确地了解腹腔镜经腹腹膜前腹股沟疝修补术术后血清肿的发生率和严重程度,便于提供更有效的治疗对策.血清肿重点在于预防.术中精细解剖,对于易感人群给予个体化处理,以期降低血清肿发生率,减少由此引起的医疗风险.