免气囊分离器完全腹膜外腹腔镜腹股沟疝修补术初步体会.docVIP

免气囊分离器完全腹膜外腹腔镜腹股沟疝修补术初步体会 　【摘要】 目的：探讨免气囊分离器完全腹膜外腹腔镜腹股沟疝修补术（totally extraperitoneal repair,TEP）的可行性、手术技巧和临床经验。方法：2005年6月至2007年5月为21例患者(23侧）行腹股沟疝免气囊分离器TEP，其中斜疝21侧，直疝、股疝各1侧。结果：所有患者均顺利完成手术，平均手术时间70min，术中平均出血16ml，术后平均住院5d。发生腹壁下血管游离5例次，腹壁气肿5例次，血肿或血清肿4例次，腹膜破损与神经感觉异常各3例次，膀胱损伤1例次。随访2～24个月，无复发。结论：免气囊分离器TEP安全可行，手术难点是正确分离腹膜外置入网片的腔隙。 【关键词】 腹腔镜检查 腹股沟 完全腹膜外径路 免气囊分离器 疝修补术 　　The initial experience of totally extraperitoneal repair of inguinal hernia without using a dissection balloon:with a report of 21 cases 　　【Abstract】 Ｏbjective:To explore the feasibility,operative skills and the experience of totally extraperitoneal repair(TEP) of inguinal hernia without using a dissection balloon.Methods:During June 2005 to May 2007,21 patients were performed 23 totally laparoscopic extraperitoneal hernia repairs for inguinal hernia without employing a dissection balloon,including 21 indirect inguinal hernia,1 direct inguinal hernia and 1 femoral hernia operations.Results:All patients were performed the operation successfully. The mean operating duration was 70min,the mean operative blood loss was 16ml,the mean postoperative hospital stay was 5 days.The epigastric vessels was torn off by avulsion in 5 cases,the emphysema in abdominal wall was formed in 5 cases,the hematoma or seroma appeared in 4 cases,the peritoneal laceration and the abnormal sense of nerve occurred in 3 cases,and one case had bladder injury.The patients were followed up for 2～24 months,no recurrence occurred.Conclusions:TEP without using dissection balloon is safe and feasible. The key process is that the extraperitoneal space must be separated accurately in order to lay the mesh. 　　【Key words】 Laparoscopy;Hernia,inguinal;Totally extraperitoneal approach; No dissection balloon; Herniorrhaphy 　　完全腹膜外腹腔镜疝修补术（totally extraperitoneal repair，TEP）是腹腔镜下腹股沟疝修补术的首选术式［1］，但TEP常规术式需使用昂贵的气囊分离器，限制了TEP的推广应用［2］。 2005年6月至2007年5月我院使用常规腹腔镜手术器械，探索免气囊分离器的TEP手术方法，完成了21例、23侧腹股沟疝TEP术，现报道如下。 　　1 资料与方法 　　1.1 临床资料 本组共21例、23侧， 男20例，女1例。25～78岁，平均5