TAPP联合腹壁小切口技术在难复位腹股沟嵌顿疝急诊手术患者中的应用(1)
[摘要] 目的 分析腹腔鏡经腹腹膜前疝修补术(Transabdominal preperitoneal，TAPP)联合腹壁小切口的杂交技术治疗急性难复位腹股沟嵌顿疝的临床疗效。 方法 回顾性分析福建中医药大学附属人民医院2017年8月～2019年8月应用TAPP联合腹壁小切口的杂交技术治疗的12例难复位腹股沟嵌顿疝急诊患者，均为单侧斜疝嵌顿，疝内容物在腔镜下用器械辅助无法完全返纳，遂取内环处腹股沟区小切口，返纳疝内容物，再完成TAPP术。观察患者术中出血量、手术时间、住院天数及术后并发症情况。 结果 嵌顿疝内容物10例为小肠，2例为大网膜。其中1例完成TAPP术后，发现小肠坏死，另取脐部小切口完成坏死小肠切除吻合。12例患者均顺利完成手术，术中出血量10～30 mL，平均(20.1±3.2) mL;手术时间80～125 min，平均(95.2±20.6) min。术后腹股沟区血清肿1例，阴囊积液2例，无腹股沟区顽固性疼痛、缺血性睾丸炎、腹腔感染、肠梗阻及切口感染病例。经过对症处理后，1周内阴囊积液及血清肿症状趋于消失。住院时间平均(4.0±1.2)d，随访3～24个月未见疝复发、腹股沟区慢性疼痛及补片感染病例。 结论 TAPP联合腹壁小切口的杂交技术治疗难复位腹股沟嵌顿疝具有康复快、创伤小等优点，如果严格掌握适应证，可在临床广泛应用。
[关键词] 疝;腹股沟;嵌顿;疝修补术;腹腔镜检查;急诊手术
[中图分类号] R726.5 [文献标识码] B [文章编号] 1673-9701(2020)19-0047-03
The application of TAPP combined with abdominal wall small incision technology to emergency operation for the patients with difficult reduction inguinal incarcerated hernia
HE Shoumin FU Jun LIU Jian'guo ZHENG Qingsheng WANG Zhi WANG Shouming
Department of General Surgery， The People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine， Fuzhou 350001， China
[Abstract] Objective To analyze the clinical efficacy of laparoscopic transabdominal preperitoneal(TAPP) hernia repair combined with abdominal wall small incision hybrid technology in the treatment of acute difficult reduction inguinal incarcerated hernia. Methods A retrospective analysis was made on 12 patients with difficult reduction inguinal incarcerated hernia who were treated through TAPP combined with abdominal wall small incision hybrid technology in The People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine from August 2017 to August 2019. All the patients had unilateral indirect inguinal incarcerated hernia. The contents of hernia could not be completely returned with the aid of instruments under endoscopy. Therefore， a small incision in the inguinal region at the inner ring was made to return the contents of hernia before TAPP was completed. The intraoperative blood loss， operation time， hospitalization days and postoperative complications of the patients were observed. Results The contents of incarcerated hernia were small intestine in 10 cases and greater omentum in 2 cases. One of them had necrosis of small intestine detected after TAPP， and another small incision was made in umbilical region to complete resection and anastomosis of necrotic small intestine. All the 12 patients successfully completed the operation. The intraoperative blood loss was 10-30 ml， with an average of (20.1±3.2) mL. The operation time was 80-125 min， with an average of (95.2±20.6) min. After operation， inguinal seroma was found in 1 case， scrotal effusion in 2 cases， and there was no case of intractable pain in inguinal region， ischemic orchitis， abdominal infection， intestinal obstruction and incision infection. After targeted treatment， the symptoms of scrotal effusion and seroma tended to disappear within one week. The average hospitalization time was(4.0±1.2) d， and no case of recurrence of hernia， chronic pain in inguinal region and sticking patch infection was found during 3 to 24 months of follow-up. Conclusion TAPP combined with abdominal wall small incision hybrid technique has the advantages of fast recovery and fewer traumas in the treatment of difficult reduction inguinal incarcerated hernia. If the strict indications are mastered， it can be applied widely in clinical practice., 百拇医药(何守敏 傅军 刘建郭 郑清盛 王梽 王守铭)
[关键词] 疝;腹股沟;嵌顿;疝修补术;腹腔镜检查;急诊手术
[中图分类号] R726.5 [文献标识码] B [文章编号] 1673-9701(2020)19-0047-03
The application of TAPP combined with abdominal wall small incision technology to emergency operation for the patients with difficult reduction inguinal incarcerated hernia
HE Shoumin FU Jun LIU Jian'guo ZHENG Qingsheng WANG Zhi WANG Shouming
Department of General Surgery， The People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine， Fuzhou 350001， China
[Abstract] Objective To analyze the clinical efficacy of laparoscopic transabdominal preperitoneal(TAPP) hernia repair combined with abdominal wall small incision hybrid technology in the treatment of acute difficult reduction inguinal incarcerated hernia. Methods A retrospective analysis was made on 12 patients with difficult reduction inguinal incarcerated hernia who were treated through TAPP combined with abdominal wall small incision hybrid technology in The People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine from August 2017 to August 2019. All the patients had unilateral indirect inguinal incarcerated hernia. The contents of hernia could not be completely returned with the aid of instruments under endoscopy. Therefore， a small incision in the inguinal region at the inner ring was made to return the contents of hernia before TAPP was completed. The intraoperative blood loss， operation time， hospitalization days and postoperative complications of the patients were observed. Results The contents of incarcerated hernia were small intestine in 10 cases and greater omentum in 2 cases. One of them had necrosis of small intestine detected after TAPP， and another small incision was made in umbilical region to complete resection and anastomosis of necrotic small intestine. All the 12 patients successfully completed the operation. The intraoperative blood loss was 10-30 ml， with an average of (20.1±3.2) mL. The operation time was 80-125 min， with an average of (95.2±20.6) min. After operation， inguinal seroma was found in 1 case， scrotal effusion in 2 cases， and there was no case of intractable pain in inguinal region， ischemic orchitis， abdominal infection， intestinal obstruction and incision infection. After targeted treatment， the symptoms of scrotal effusion and seroma tended to disappear within one week. The average hospitalization time was(4.0±1.2) d， and no case of recurrence of hernia， chronic pain in inguinal region and sticking patch infection was found during 3 to 24 months of follow-up. Conclusion TAPP combined with abdominal wall small incision hybrid technique has the advantages of fast recovery and fewer traumas in the treatment of difficult reduction inguinal incarcerated hernia. If the strict indications are mastered， it can be applied widely in clinical practice., 百拇医药(何守敏 傅军 刘建郭 郑清盛 王梽 王守铭)