精索结构全程非去腹膜化在青年腹股沟疝腹腔镜经腹膜前疝修补术中的应用探索

Application of whole non-deperitonealization of spermatic structure in laparoscopic trans-abdominal preperitoneal repair of young inguinal hernia

摘要:

目的 探讨精索结构全程非去腹膜化在青年腹股沟疝腹腔镜经腹膜前疝修补术（TAPP）中的可行性及安全性，旨在保护青年腹股沟疝患者的生育功能。方法 回顾性分析2019年7月－2020年12月丽水市中心医院胃肠腹壁疝外科52例行精索结构全程非去腹膜化的腹腔镜TAPP患者的临床资料，观察患者术后疗效。采用门诊就诊和电话随访等方式收集患者术后恢复非限制性活动时间和术后并发症发生情况（术后血清肿、切口感染、慢性疼痛、睾丸萎缩、疝复发和补片移位情况）。结果 所有患者术中均未发生严重并发症，围手术期无死亡病例。手术时间单侧为（56.4±12.7）min，双侧为（87.3±11.7）min，术中出血量小于5 mL，无中转改开放手术患者。术后肛门首次排气时间为（21.5±9.2）h，92.3%（48/52）的患者术后不需要使用镇痛药物，术后2 d内均可按计划出院，出院前均未发现术区水肿、阴囊积液和术后发热。术后所有患者均维持电话随访，随访时间9～26个月。其中，随访1年的9例，随访1年以上的43例。电话随访患者出院2周后均已恢复非限制性活动。其中，术后阴囊积液2例，发生率为3.8%（2/52）。长期随访未发现切口感染及慢性疼痛，未发现疝复发情况。结论 精索结构全程非去腹膜化在青年腹股沟疝腹腔镜TAPP中的应用是安全、可行的。

Abstract:

Objective To investigate the feasibility and safety of whole non-deperitonealization of spermatic structure in laparoscopic trans-abdominal preperitoneal (TAPP) for young inguinal hernia patients, in order to protect the reproductive function in young inguinal hernia patients.Methods Clinical data of 52 patients with whole non-deperitonealization of spermatic structure in laparoscopic TAPP from July 2019 to December 2020 were retrospectively analyzed. The curative effect of the patients was observed after operation. The time for patients to resume non-restricted activities after surgery and the incidence of postoperative complications (postoperative seroma, incision infection, chronic pain, testicular atrophy, hernia recurrence and mesh displacement) were collected by outpatient visits and telephone follow-up.Result There were no serious complications and no deaths perioperative period. The operative time unilateral was (56.4 ± 12.7) min, bilateral was (87.3 ± 11.7) min, blood loss was less than 5 mL, no conversion to open surgery during operation. The first exhaust time after operation was (21.5 ± 9.2) h, 92.3% (48/52) of patients did not need to use analgesic drugs after surgery. Discharge after operation within 2 d as planned. No edema, scrotal effusion and postoperative fever were found before discharge. All these patients were followed up by telephone for 9 ~ 26 months, including 9 patients within 1 year and 43 patients more than 1 year. All these patients have returned to non-restrictive activity 2 weeks after discharge by telephone follow-up, and 2 cases of scrotal effusion was found, the incidence was 3.8% (2/52). Long-term follow-up did not find incision infection and chronic pain, no recurrence of hernia.Conclusion It is safe and feasible to apply whole non-deperitonealization of spermatic structure in laparoscopic TAPP of young inguinal hernia.