腹腔镜腹股沟疝修补术.pptxVIP

腹腔镜腹股沟疝修补术（LIHR） 及3D补片的应用 -- The application of LIHR and 3D mesh 南京医科大学附属南京第一医院 普外科 曹红勇 Hongyong Cao腹腔镜腹股沟疝修补术（LIHR） Laparoscopic inguinal hernia repair腹股沟疝的发病基础: etiology of inguinal hernia 肌耻骨孔 myopectineal orifice 肌耻骨孔 myopectineal orifice 腹股沟疝修补的目标—完整覆盖肌耻骨孔完整覆盖肌耻骨孔有三层不同的修补层次Reconstruction of three differtent layers（1）腹横筋膜前的肌前修补 Extra-transverse fascia repair（2）腹横筋膜后的腹膜前修补 Extra-peritoneal repair（3）腹腔内修补 Intra-peritoneal repair腹腔镜腹股沟疝修补术（LIHR） Laparoscopic inguinal hernia repair（1）完全腹膜外修补术（totally extraperitoneal TEP）（2）经腹腹膜前疝修补术（transabdominal preperitoneal TAPP）（3）腹膜内补片植入术疝修补术（intraperitoneal onlay mesh IPOM）LIHR手术的合理性WHY LIHR?1.符合病因学说，腹横筋膜重建。Rebuild the transverse fascia 2.符合解剖结构，完全修复了腹股沟部位的薄弱区域。Cover the entire weak parts of inguinal area 3.符合力学原理，有效缓冲腹腔内压力的冲击Buffer the pressure of peritoneal cavity LIHR手术的适应证 Indication优先考虑：双侧疝和复发疝Ideally suitable for relapse hernia and bilateral hernia适用于：I型、II型、III型和IV型的腹股沟直疝、斜疝和股疝Adapt to (type-I/ II/ III/ IV) indirect hernia、direct hernia and femoral hernia ------（中华外科学会疝与腹壁外科学组2003年8月修订稿）LIHR手术的禁忌证 Contra-indication1.不能耐受麻醉和气腹者。intolerance of anesthesia and pneumoperitoneum 2.严重出血倾向者。serious hemorrhagic tendency 3.嵌顿疝、绞窄疝。incarcerated hernia and strangulated hernia4.腹腔镜手术后严重粘连者。severe Post-laparoscopic operation adhesion 5.复杂滑动疝。complicated sliding hernia 6.合并妊娠者。combined with pregnancy LIHR手术的优点 Advantages1.切口小，疼痛轻，美观。Small incision — Less pain — Better outlook 2.避免了由于切口所致的组织损伤，神经损伤，切口感染。Small wound area — Low risk of infection and tissue damage3.局部的紧张感，异物感轻微。Tension-free — More comfortable4.空间大，视野清晰，解剖标志明显，补片易于放置到位，展平。Allowed clear visualization of all preperitoneal fascial planes and anatomic landmarksEasy to fix the mesh to planned placeLIHR手术的优点 Advantages5.术中可探查是否有隐匿疝，并得到及时的治疗。Find and treat mutiple unexpected and concealed hernia 6.治疗双侧疝、复合疝与复发疝具有一定的优势。Ideally suitable for relapse hernia、bilateral hernia and complicated hernia7.允许患者术后更早的回复非限制性活动。Quicker recovery — a shorter hospitalization per