腹腔镜经腹腹膜前疝修补术中采用疝囊剥离与横断处理治疗Ⅲ型腹股沟疝的对比研究

摘要

Objective:To compare the efficacy of dissection and transection of hernia sac in laparoscopic transabdominal preperitoneal ( TAPP) inguinal hernia repair for typeⅢinguinal indirect hernia.Methods:Clinical data of 128 adult male patients with typeⅢinguinal indirect hernia who underwent laparoscopic TAPP inguinal hernia repair between Jan.2013 and Jul.2015 were retro-spectively analyzed.There were 68 cases of transection of hernial sac in TAPP laparoscopic inguinal herniorrhaphy as group transection and 60 cases of dissection of hernial sac in TAPP laparoscopic inguinal herniorrhaphy as group dissection.The clinical efficacy between the two groups were analyzed and compared.Results:All the two groups were successfully completed.Compared with group dissection, the operative time and intraoperative bleeding volume,the rate of postoperative seroma and temporary nerve paresthesia in group transec-tion was significantly decreased (P<0.05).There was no statistical difference for the postoperative hospital stay or recurrence rate (P>0.05).Conclusions:Dissection and transection of hernia sac are both safe and effective techniques.Transection of hernial sac in TAPP laparoscopic inguinal herniorrhaphy for typeⅢinguinal indirect hernia could reduce the difficulty of operation,shorten operation duration,reduce intraoperative bleeding volume,decrease postoperative seroma and temporary nerve paresthesia,is less invasive,safe, reliable and worth the clinical adoption and promotion.%目的：比较腹腔镜经腹腹膜前修补术（ transabdominal preperitoneal，TAPP）术中对Ⅲ型腹股沟斜疝疝囊采用完全剥离与横断处理两种方法的临床疗效。方法：回顾分析2013年1月至2015年7月为128例成年男性单侧Ⅲ型腹股沟斜疝患者行腹腔镜TAPP的临床资料，其中68例术中横断疝囊（横断组），60例剥离疝囊（剥离组），对比分析两组患者相关临床指标。结果：两组均成功完成手术。横断组手术时间、术中出血量均少于剥离组（P＜0．05）；术后血清肿、暂时性神经感觉异常发生率低于剥离组（P＜0．05）；两组术后住院时间及复发率差异均无统计学意义（P＞0．05）。结论：疝囊剥离与疝囊横断两种处理方法均是安全、有效的，腹腔镜TAPP治疗Ⅲ型腹股沟斜疝术中横断疝囊可降低手术操作难度，缩短手术时间，减少术中出血量，降低术后血清肿、暂时性神经感觉异常发生率，创伤更小，且安全可靠，值得推广应用。