腹膜主动切开技术在腔镜全腹膜外疝修补术中保留子宫圆韧带的应用

doi:10.3969/j.issn.1009-976X.2020.05.007

摘要/Abstract

摘要： 目的探讨腹腔镜全腹膜外疝修补术（TEP）中,腹膜主动切开技术在保留子宫圆韧带中的应用价值。方法回顾性分析2014年1月年至2019年10月,中山市博爱医院普外科施行女性TEP术41例患者临床及手术资料,将其中应用腹膜主动切开技术保留子宫圆韧带及切断子宫圆韧带患者进行比较,对比手术时间、手术出血量,以及术后并发症的发生率。结果腹膜主动切开技术保留子宫圆韧带21例,切断子宫圆韧带20例,各组手术时间、手术出血量、住院天数及住院费用差异无统计学意义;两组术后疼痛、血清肿形成、腹股沟区异物感无统计学意义（P>0.05）。结论腹膜主动切开技术保留子宫圆韧带在TEP术中应用安全、可靠,不增加腹股沟疝复发及术中、术后并发症,并可保护子宫圆韧带原有解剖关系及功能。

关键词: 子宫圆韧带, 腹股沟疝, 腔镜全腹膜外疝修补术

Abstract: Objective To explore the application value of active peritoneal incision in the preservation of round ligament of uterus in laparoscopic total extraperitoneal hernia repair （TEP）. Methods From January 2014 to October 2019, 41 cases of TEP in general surgery department of Zhongshan Boai hospital were analyzed retrospectively, and the clinical and surgical data of them were compared. The time of operation, the amount of bleeding and the incidence of postoperative complications were compared. Results There were no significant differences in operation time, bleeding volume, hospitalization days and hospitalization expenses among the groups. The postoperative pain, seroma formation, and foreign body sensation in the groin area were not statistically significant in the two groups （P<0.05）. There was no intraoperative side injury in each group. The incidence of postoperative complications was 0. Conclusion The technique of active peritoneal incision is safe and reliable in the application of TEP, which can not increase the recurrence of inguinal hernia and complications during and after operation, and can protect the original anatomical relationship and function of the ligament.

Key words: inguinal hernia, cyst of round ligament of uterus, extraperitoneal hernia repair

中图分类号:

R656.2

梁文丰, 周建平, 廖子聪, 汤治平. 腹膜主动切开技术在腔镜全腹膜外疝修补术中保留子宫圆韧带的应用[J]. 岭南现代临床外科, 2020, 20(05): 577-581.

LIANG Wen-feng, ZHOU Jian-ping, LIAO Zi-cong, TANG Zhi-ping. Application of active peritoneal incision in the maintenance of round ligament of uterus in laparoscopic total extraperitoneal hernia repair[J]. Lingnan Modern Clinics in Surgery, 2020, 20(05): 577-581.

参考文献

[1] Hernia Surge Group.International guidelines for groin hernia management[J]. Hernia, 2018, 22(1): 1-165.
[2] Yang XF, Liu JL.Laparoscopic repair of inguinal hernia in adults[J]. Ann Transl Med, 2016, 4(20): 402.
[3] Schmidt L, Andresen K, Öberg S, Rosenberg J.Dealing with the round ligament of uterus in laparoscopic groin hernia repair: a nationwide survey among experienced surgeons[J]. Hernia, 2018, 22(5): 849-855.
[4] 陈瑶,等. 女性腹腔镜腹股沟疝修补术子宫圆韧带的处理方式[J]. 中华消化外科杂志, 2018. 17(11): 1137-1140.
[5] Mahran M, Ghaleb HA.The physiology of the human round ligament[J]. J Obstet Gynaecol Br Commonw, 1964, 71:374-378
[6] Yen CF, Wang CJ, Lin SL, et al.Combined laparoscopic uterosacral and round ligament procedures for treatment of symptomatic uterine retroversion and mild uterine decensus[J]. J Am Assoc Gynecol Laparosc, 2002, 9(3): 359-366.
[7] Gargiulo T, Leo L, Gomel V.Laparoscopic uterine suspension using three-stitch technique[J]. J Am Assoc Gynecol Laparosc, 2000, 7(2): 233-236.
[8] Halperin R, Padoa A, Schneider D, et al.Long-term follow-up (5-20 years) after uterine ventrosuspension for chronic pelvic pain and deep dyspareunia[J]. Gynecol Obstet Invest, 2003, 55(4):216-219
[9] Schmidt L, Andresen K, Öberg S, et al.Dealing with the round ligament of uterus in laparoscopic groin hernia repair: a nationwide survey among experienced surgeons[J]. Hernia, 2018, 22(5): 849-855.
[10] 唐健雄. 现代疝外科解剖和治疗原则的新认识[J]. 中华消化外科杂志, 2015, 14(10): 806-810.
[11] Bittner R, Bingener-Casey J, Dietz U, et al.Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias (International Endohernia Society (IEHS)-Part 1[J]. Surgical Endoscopy, 2014, 28(1): 2-29.
[12] Fauconnier A, Dubuisson JB, Foulot H, et al.Mobile uterine retroversion is associated with dyspareunia and dysmenorrhea in an unselected population of women[J]. Eur J Obstet Gynecol Reprod Biol, 2006, 127(2):252-256.
[13] Batioglu S, Zeyneloglu HB.Laparoscopic plication and suspension of the round ligament for chronic pelvic pain and dyspareunia[J]. J Am Assoc Gynecol Laparosc, 2000. 7(4): 547-551.
[14] Ou CS, Liu YH, Joki JA, Rowbotham R.Laparoscopic uterine suspension by round ligament plication[J]. J Reprod Med, 2002, 47(3): 211-216.
[15] Hsieh CH.A new laparoscopic technique for uterine prolapse: one-sided uterine fixation through the round ligament[J]. Int Urogynecol J, 2011, 22(2): 213-219.