TEP术中导致腹膜破裂的原因和处理

doi:10.3969/j.issn.1009-976X.2021.03.014

摘要/Abstract

摘要： 目的探讨腹腔镜下腹膜外腹股沟疝修补术（TEP）手术中腹膜破裂后处理对策。方法回顾分析2015年1月~2020年1月在我院腹股沟疝行TEP手术的所有病例,总结TEP手术中腹膜破裂的原因、裂口的大小、位置及处理对策。比较同期病例腹股沟疝修补术中腹膜破裂和完整的患者手术时间、中转术式、手术并发症、住院时间的差异。结果本组141例TEP手术中,腹膜完整无破裂58例,腹膜破裂83例,初期有2例中转TAPP。腹膜无破裂组患者的手术时间42.34±13.52 min,腹膜破裂组患者的手术时间57.13±18.38,两组对比P<0.01。术后血清肿,术后脐部切口红肿,局部疼痛,住院天数、手术并发症无明显差异,随访6~24月无复发,患者无特殊不适,恢复正常工作生活。结论 TEP手术中腹膜破裂会影响手术操作空间,延长麻醉和手术时间,除了患者本身情况外,还与术者的操作经验有关,但不增加手术并发症和住院时间。

关键词: 腹腔镜, 腹股沟斜疝, 腹膜破裂, 并发症

Abstract: Objective To explore the management for peritoneal tears during laparoscopic extraperitoneal inguinal hernia repair （TEP）. Methods A retrospective analysis was performed in 141 cases with TEP surgery from January 2015 to January 2020, to analyze the causes of peritoneal rupture during TEP surgery, the size and location, and the management. The operation time, transfer procedure, surgical complications, and hospital stay were compared between patients with and without peritoneal tears during inguinal hernia repair in the same period. Results Among the 141 cases of TEP surgery in this group, 58 cases had intact peritoneum without rupture, 83 cases had peritoneal tears, and 2 cases were transferred to TAPP. The operation time of patients in the peritoneal rupture group was 42.34±13.52 min, and the operation time of patients in the peritoneal tears group was 57.13±18.38 （P<0.01）. Postoperative seroma, postoperative umbilical incision redness and swelling, local pain, hospitalization days, surgical complications were no significant statistical differences follow-up 6 to 24 months. The patient has no special discomfort, and resumed normal work and life. Conclusion The peritoneal tears during TEP operation will collapsing preperitoneal space and prolong the anesthesia and operation time. In addition to the patient′s own condition, it is also related to the operator′s operating experience, but does not increase surgical and hospital stay.

Key words: peritoneal tears, extraperitoneal inguinal hernia repair （TEP）, complications

中图分类号:

R656.2

周建平, 徐飞, 梁文丰, 汤治平. TEP术中导致腹膜破裂的原因和处理[J]. 岭南现代临床外科, 2021, 21(03): 321-324.

ZHOU Jian-ping, XU Fei, LIANG Wen-feng, TANG Zhi-ping. Treatment of peritoneal tears during laparoscopic extraperitoneal inguinal hernia repair[J]. Lingnan Modern Clinics In Surgery, 2021, 21(03): 321-324.

参考文献

[1] 汤治平,赵象文,梁志宏,等. 腹膜外间隙空间的建立与细分对耻骨肌孔后腹股沟疝修补术的意义[J]. 解剖学研究, 2010, 32(5): 344-348.
[2] Simons MP, AufenackerT, Bay-Nielsen M, et al. European Hernia Society guidelines on the treatment of inguinal hernia in adult patients[J]. Hernia, 2009, 13(4): 343-403.
[3] 陈双,杨斌. 解读欧洲疝学会的《成人腹股沟疝治疗指南》[J]. 外科理论与实践, 2010, 15(6): 668-670.
[4] 周学鲁, 黄海, 骆剑华, 等. 于膜解剖的腹腔镜全腹膜外腹股沟疝修补术[J/CD]. 中华普通外科学文献 (电子版), 2019, 13(4): 296-299.
[5] 汤治平, 苏远航, 陈双. 主动腹膜切开在完全腹膜外疝修补术中的应用[J/CD]. 中华疝和腹壁外科杂志 (电子版), 2013, 7(3): 210-211.
[6] Gui B, Valentini AL, Ninivaggi V, et al.Deep pelvic endometriosis: don't forget round ligaments. Review of anatomy, clinical characteristics, and MR imaging features[J]. Abdom Imaging, 2014, 39(3): 622-632.
[7] 刘昶, 杨凯,纪艳超, 等. 腹腔镜经腹腹膜前修补股疝并子宫圆韧带重建8例疗效分析[J]. 中国实用外科杂志, 2015, 35(2): 195-197.
[8] 中华医学会外科学分会腹腔镜与内镜外科学组, 中华医学会外科学分会疝与腹壁外科学组, 大中华腔镜疝外科学院. 腹股沟疝腹腔镜手术规范化操作指南[J]. 中国实用外科杂志, 2013, 33(7): 566-570.
[9] Franklin ME, Diaz-Elizondo JA.The intraperitoneal onlay mesh procedure for groin hernias.//Fitzgibbons RJ, Greenburg AG (eds) Nyhus and Condon_s hernia[M]. Lippincott Williams & Wilkins, Philadelphia, 2002: 269-278.
[10] Layman TS, Burns RP, Chandler KE, et al.Laparoscopic inguinal herniorrhaphy in a swine model. Third place winner of the Conrad Jobst Award in the Gold Medal paper competition[J]. Am Surg, 1993, 59(1): 13-19.
[11] Voeller GR.Management of peritoneal tears during endoscopic extraperitoneal inguinal hernioplasty[J]. Surg Endosc, 2003, 17(8): 1335.
[12] Tran HM, Tran K, Zajkowska M, et al. Single-incision laparoscopic intraperitoneal onlay mesh repair for the treatment of multiple recurrent inguinal hernias [J]. JSLS, 2014, 18(3): e2014. 00354.
[13] Shpitz B, Lansberg L, Bugayev N, et al.Should peritoneal tears be routinely closed during laparoscopic total extraperitoneal repair of inguinal hernias? A reappraisal[J]. Surg Endosc, 2004, 18(12): 1771-1773
[14] Yang GPC.From intraperitoneal onlay mesh repair to preperitonealonlay mesh repair[J]. Asian J Endosc Surg, 2017, 10(2): 119-127.
[15] Ng WT.Should peritoneal tears be routinely closed during total extraperitoneal repair of inguinal hernias?[J]. Surg Endosc, 2006, 20(12): 1928-1929.