摘要
目的探讨腹腔镜手术治疗女性腹股沟疝的临床特点。方法回顾性分析2001年1月至2013年12月上海交通大学医学院附属瑞金医院行腹腔镜修补术的225例(246侧)女性腹股沟疝病人的临床资料。采用经腹腹膜前修补术(TAPP)治疗170例(183侧),全腹膜外修补术(TEP)治疗55例(63侧)。按术中是否保留子宫圆韧带分为保留组(95例,104侧)和切断组(131例,142侧)。对比分析两组病人术中及术后情况。结果 (1)保留组中19侧子宫圆韧带能够自然腹壁化,5侧沿子宫圆韧带两侧切开腹膜后再缝合,均采用传统方法将补片平铺在子宫圆韧带前方;80侧采用内环口整形术(Keyhole法),将补片置于子宫圆韧带的后方。保留组采用TAPP 90侧(86.5%),TEP 14侧(13.5%);切断组采用TAPP 93侧(65.5%),TEP 49侧(34.5%)(P=0.002)。保留组和切断组病人的平均年龄分别为(41.2±1.7)岁和(62.3±1.2)岁(P<0.000);手术时间分别为(31.3±1.3)min和(25.0±1.0)min(P<0.000)。(2)手术无中转。术后住院时间为(1.5±0.2)d,2周内均恢复非限制性活动。术后血清肿10例(4.5%),尿潴留2例(1.0%)。随访期内无复发。结论腹腔镜手术治疗女性腹股沟疝时,子宫圆韧带是否切断须考虑年龄、手术时间、复发率等多方面因素;如保留子宫圆韧带,切开腹膜再缝合和Keyhole法是可选择的两种方法。
Objective To explore the clinical characteristics of laparoscopy in the treatment of inguinal hernia in female patients. Methods The clinical data of 246 hernias in 225 female patients performed laparoscopy between January 2001 and December 2013 in Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine were analyzed retrospectively. All the procedures included 170 TAPPs for 183 hernias and 55 TEPs for the remaining 63 ones. According to the maintenance of round ligaments, the data were classified into preservation group （104 hernias in 95 patients） and transection group （142 hernias in 131 patients）. The intraoperative and postoperative data between two groups were compared. Results （1） In preservation group, 19 round ligaments were completely parietalized and 5 were dissected by openning and re-suturing the peritoneum around the round ligament. The meshes were placed in front of the ligament. For the remaining 80 hernias, the meshes were placed behind the ligament by keyhole technique. A total of 90 TAPPs （86.5%） and 14 TEPs （13.5%） were performed in the preservation group, and the numbers are 93 （65.5%） and 49 （34.5%） in the transection group （P=0.002）. The average ages in preservation and transection groups was （41.2± 1.7 ）and （ 62.3± 1.2） years old （P〈0.000） respectively. The time of operation in preservation group is （31.3± 1.3 ） minutes, compared to （25.0± 1.0）minutes in transection group （P〈0.000）. （2） No conversion to laparotomy occurred. The postoperativehospitalization is （1.5 ± 0.2） days. All patients returned to normal activity within 2 weeks. No recurrence but 10 patients with seroma （4.5%） and 2 urinary retention （1.0%） were noted in the follow-ups. Conclusion The surgeon should thoroughly evaluate multiple factors, includingage, time of operation, recurrenee and ete., before transeeting the round ligament. Both peritoneum dissection and re-suture technique and inner ring keyhole technique are available for the preservation.
出处
《中国实用外科杂志》
CSCD
北大核心
2015年第11期1220-1222,共3页
Chinese Journal of Practical Surgery
基金
吴阶平医学基金会临床科研专项资助基金(No.320.6750.14321)
关键词
女性
腹腔镜
腹股沟疝
子宫圆韧带
female
laparoscnpy
inguinal hernia
round ligament of uterus
