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中华疝和腹壁外科杂志(电子版) ›› 2018, Vol. 12 ›› Issue (01) : 30 -33. doi: 10.3877/cma.j.issn.1674-392X.2018.01.007

所属专题: 文献

论著

负压引流在腹腔镜经腹腹膜前疝修补术后减少血清肿的临床应用
司仙科1, 李炜1, 杨佳华1, 郑侃1, 张计训1, 华蕾1,()   
  1. 1. 200062 上海中医药大学附属普陀医院普外科
  • 收稿日期:2017-11-16 出版日期:2018-02-15
  • 通信作者: 华蕾
  • 基金资助:
    上海中医药大学附属普陀医院院级课题项目(2016122B)

Application of negative pressure drainage for reducing seroma after Transabdominal Preperitoneal

Xianke Si1, Wei Li1, Jiahua Yang1, Kan Zhen1, Jixun Zhang1, Lei Hua1,()   

  1. 1. Department of Minimally Invasive Surgery, Putuo Hospital Affiliated to Shanghai University of TCM, Shanghai 200062, China
  • Received:2017-11-16 Published:2018-02-15
  • Corresponding author: Lei Hua
  • About author:
    Corresponding auther: Hua Lei, Email:
引用本文:

司仙科, 李炜, 杨佳华, 郑侃, 张计训, 华蕾. 负压引流在腹腔镜经腹腹膜前疝修补术后减少血清肿的临床应用[J]. 中华疝和腹壁外科杂志(电子版), 2018, 12(01): 30-33.

Xianke Si, Wei Li, Jiahua Yang, Kan Zhen, Jixun Zhang, Lei Hua. Application of negative pressure drainage for reducing seroma after Transabdominal Preperitoneal[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2018, 12(01): 30-33.

目的

探讨腹腔镜经腹腹膜前疝修补术(transabdominal preperitoneal,TAPP)中放置负压引流管在减少术后血清肿发生的临床应用价值。

方法

将2016年2月至2017年2月,上海中医药大学附属普陀医院连续收治的68例成人单侧Ⅱ、Ⅲ型腹股沟斜疝患者随机分为2组,均接受TAPP术。其中引流组38例,在关腹膜前将十字形负压引流管放置于疝补片与腹膜之间,引流管从同侧戳卡孔引出接负压吸球。对照组30例,未放置负压引流。将2组患者的手术时间、术后住院时间、术后血清肿发生率进行比较。

结果

68例患者均顺利出院,引流组平均手术时间较对照组长[(52.50±12.06)min比(48.83±15.23)min],但差异无统计学意义(P>0.05)。引流组术后平均住院时间较对照组长[(3.29±0.98)d比(1.93±0.69)d],差异有统计学意义(P<0.05)。引流组血清肿发生率明显低于对照组[2.6%(1/38)比26.7%(8/30)],差异有统计学意义(P<0.05)。

结论

负压引流可观察术后积液或出血情况,降低血清肿发生;负压管还可有效减少死腔,防止补片移动。十字形负压引流无侧孔洞,引流效果佳,不易堵塞,拔除便捷,不易使补片移位。

Objective

To evaluate the efficacy of negative pressure drainage for reducing seroma after transabdominal preperitoneal(TAPP).

Methods

From Feb.2016 to Feb.2017, 68 consecutive adult patients with unilateral indirect inguinal hernia in Putuo Hospital Affiliated to Shanghai University of TCM were randomly divided into two groups and underwent TAPP.38 cases in the drainage group had a cross-type negative pressure drainage tube placed between the mesh and peritoneum before suturing peritoneum, while 30 cases in the control group without any drainage tube. The operative time, hospital stays and the incidence rate of seroma between the two groups were compared.

Results

All 68 patients had smooth recovery. Compared with the control group, the drainage group had a longer average operative time (52.50±12.6 min vs. 48.83±15.23 min; P>0.05), but this result was not statistically significant, and also had a longer hospital stays after operation (3.29±0.98 day vs. 1.93±0.69 day; P<0.05), the result was statistically significant. Incidence of seroma in drainage group was obviously lower than that in the control group (1/38, 2.6% vs. 8/30, 26.7%; P<0.05), the result was significantly different.

Conclusion

Negative pressure drainage is helpful to observe fluid collection and bleeding after surgery, and to reduce the incidence of seroma. In addition, the negative pressure drainage tube can reduce dead space and prevent the migration of the mesh. The cross-type negative pressure drainage tube has no side holes with better drainage effect and is not easy to be blocked. The removal of drainage tube is convenient, and not easy to cause mesh migration.

表1 2组患者一般资料比较(±s
图1 腹膜另打孔引出负压引流管
图2 缝合关闭腹膜
图3 引流管从同侧Trocar孔引出
[1]
李健文,王明刚,唐健雄, 等. 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.
[2]
Souba WW. Laparoscopic hernia repair[M]. In: ACS surgery principles practice. WebMD professional Publishing, Inc. 2005.
[3]
Birch DW. Characterizing laparoscopic incisional hernia repair[J]. Can J Surg, 2007, 50(3): 195-201.
[4]
姚胜,李基业. B超检查诊断腹壁疝无张力修补术后积液[J], 外科理论与实践, 2009, 14(2): 215-216.
[5]
Muysoms F,Campanelli G,Champault GG, et al. EuraHS: the development of an international online platform for registration and outcome measurement of ventral abdominal wall hernia repair[J]. Hernia, 2012, 16(3): 239-250.
[6]
李文君,夏鑫,孙喜太, 等. 腹腔镜腹股沟疝修补术后血清肿的探讨[J/CD], 中华腔镜外科杂志(电子版), 2014, 7(6): 473-475.
[7]
曾玉剑,孙亮,施承民, 等. 经腹腹膜前腹股沟疝修补术618例[J/CD]. 中华疝和腹壁外科杂志(电子版), 2014, 8(5): 409-411
[8]
Novik B,Hagedorn S,Mork UB, et al. Fibrin glue for securing the mesh in laparoscopic totally extraperitoneal inguinal hernia repair: a study with a 40-month prospective follow-up period[J]. Surg Endosc, 2006, 20(3): 462-467.
[9]
王明刚,陈杰,申英末, 等. 腹腔镜腹股沟疝修补术中疝固定器与医用胶固定补片的疗效研究[J]. 北京医学, 2010, 32(7): 528-530.
[10]
Honigmann P,Fischer H,Kurmann A, et al. Investigating the effect of intra-operative infiltration with local anaesthesia on the development of chronic postoperative pain after inguinal hernia repair, a randomized placebo controlled triple blinded and group sequential study design[J]. BMC Surg, 2007, 7: 22.
[11]
Hollinsky C,Sandberg S,Koch T, et al. Biomechanical properties of lightweight versus heavyweight meshes for laparoscopic inguinal hernia repair and their impact on recurrence rates[J]. Surg Endosc, 2008, 22(12): 2679-2685.
[12]
吴日钊,隋梁,李亮, 开放式双侧腹股沟疝腹膜前修补术防治血清肿的临床研究[J/CD]. 中华疝和腹壁外科杂志(电子版), 2011, 5(8): 282-288.
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