三维立体补片行免固定腹腔镜腹股沟疝修补术47例临床分析

Laparoscopic inguinal hernia repair using an anatomically contoured three-dimensional mesh without fixation:an analysis of 47 cases

关键词:  疝  腹股沟  腹腔镜  补片  疝修补术

Key words:  hernia  inguinal  laparoscopy  mesh  herniorrhaphy

摘要:

目的　总结应用三维立体补片（3DMax补片)行免固定腹腔镜下经腹腹膜前补片植入术（TAPP)的经验、技巧及体会。　方法　2009年7月—2012年1月应用TAPP术治疗47例腹股沟疝患者，同时选取在同期行无张力疝修补术的患者50例作为对照。比较两组患者在手术时间、手术费用、住院天数、并发症、正常活动时间、腹股沟疼痛持续时间、疝复发等情况。　结果　全部手术均获成功,住院天数、恢复正常活动时间、腹股沟疼痛持续时间、并发症等方面TAPP组优于开放性无张力疝修补术组, 差异有显著性意义(P<0.05)。手术时间、复发例数TAPP组多于无张力疝修补术组,但差异无显著性意义（P>0.05）。手术费用高于无张力疝修补组(P<0.05)。　结论　应用三维立体补片（3DMax补片）免固定腹腔镜下经腹腹膜前补片植入术（TAPP)，安全可靠，恢复时间短，并发症发生率低，对于复发疝以及双侧疝更加具有优势，但费用较高。

Abstract:

Objective　To summary the experience and skills of laparoscopic transabdominal preperitoneal hernia repair(TAPP) using three-dimensional mesh ( 3DMax mesh ) without fixation.　Methods　Forty-seven cases with adult inguinal hernia were underwent TAPP from July 2009 to January 2012,at the same time, 50 cases of tension free herniorrhaphy were used as control.Compared the two groups patients in operation time,costs in hospital,the duration in hospital,complication,time to normal activities,pain time in groin,and recurrence.　Results　The operation for all patients was performed successfully.The duration in hospital, time to normal activities, pain time in groin, complications in TAPP was more than those in the other group significantly.There was a significant difference in two groups(P<0.05). There was no significant difference in two groups in operation time,recurrence rate(P>0.05).Costs in hospital in TAPP were more than those in the other group(P<0.05).　Conclusions　Compared tension free herniorrhaphy,laparoscopic transabdominal preperitoneal hernia repair(TAPP),three-dimensional mesh (3DMax mesh) without fixation is safe with shorter recovery time and low complication rate, the TAPP is more advantageous in recurring hernia，and bilateral hernia. but it is more expensive.