切换至 "中华医学电子期刊资源库"

中华疝和腹壁外科杂志(电子版) ›› 2019, Vol. 13 ›› Issue (01) : 6 -9. doi: 10.3877/cma.j.issn.1674-392X.2019.01.003

所属专题: 文献

述评

腹腔镜腹股沟疝修补术后浆液肿的预防措施
李俊生1,(), 邵翔宇1, 程韬1, 嵇振岭1   
  1. 1. 210009 南京,东南大学附属中大医院普外科
  • 收稿日期:2018-10-10 出版日期:2019-02-18
  • 通信作者: 李俊生

Preventive managemengt for postoperative seroma after laparoscopic inguinal hernia repair

Junsheng Li1,(), Xiangyu Shao1, Tao Cheng1, Zhenling Ji1   

  1. 1. Department of General Surgery, Zhongda Hospital, Southeast University, Nanjing 210009, China
  • Received:2018-10-10 Published:2019-02-18
  • Corresponding author: Junsheng Li
  • About author:
    Corresponding author: Li Junsheng, Email:
引用本文:

李俊生, 邵翔宇, 程韬, 嵇振岭. 腹腔镜腹股沟疝修补术后浆液肿的预防措施[J]. 中华疝和腹壁外科杂志(电子版), 2019, 13(01): 6-9.

Junsheng Li, Xiangyu Shao, Tao Cheng, Zhenling Ji. Preventive managemengt for postoperative seroma after laparoscopic inguinal hernia repair[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2019, 13(01): 6-9.

腹腔镜腹股沟疝修补术后的浆液肿发生率较高,浆液肿是腹腔镜腹股沟疝修补术后常见的现象。关于如何预防腹腔镜疝术后浆液肿的发生,尚无一致意见。本文阐述了腹腔镜疝术后浆液肿发生的机理,易发因素及预防措施,并介绍了我们在这方面的临床经验。腹股沟直疝及大的斜疝或者阴囊疝术后浆液肿发生率较高。对于腹股沟直疝,可以在腹腔镜疝直疝修补术时将疝囊关闭(采用倒刺缝线或者endoloop)值得推荐,对于较大的腹股沟斜疝,可以尝试采用倒刺缝线悬吊远端疝囊,对于某些特殊情况,可以选择性放置引流管,早期拔出引流。

The seroma is a common complication after laparoscopic inguinal hernia repair. There is no consistent opinion on how to prevent the occurrence of seroma after laparoscopic hernia surgery. This article describes the mechanism, risk factors and preventive management of postoperative seroma following laparoscopic hernia repair, and introduces our clinical experience in this field. The incidence of seroma in the direct inguinal hernia and the large indirect or scrotal hernia is high. For the direct inguinal hernias, it is recommended to close the hernia sac during laparoscopic hernia repair (with barbed suture or endoloop). For large indirect inguinal hernias, it can be performed with distal sac hung with a barbed suture. For some special cases, it can selectively place the drainage tube and pull out the drainage at an early stage.

图1 采用倒刺线沿着直疝缺损边缘缝合腹横筋膜环周3~4针
图2 应用倒刺线贯穿缝合拉出的腹横筋膜底部
图3 拉紧倒刺缝线,关闭直疝缺损,必要时增加缝合固定
图4 离断阴囊疝的疝囊,拉住远端疝囊的下瓣腹膜
图5 采用倒刺线将离断的疝囊远端下瓣缝合到前腹壁悬吊,1~2针
[1]
Cihan A, Ozdemir H, Uçan BH, et al. Fade or fate. Seroma in laparoscopic inguinal hernia repair[J]. Surg Endosc, 2006, 20(2): 325-328.
[2]
Ferzli GS, Kiel T. The role of the endoscopic extraperitoneal approach in large inguinal scrotal hernias[J]. Surg Endosc, 1997, 11(3): 299-302.
[3]
Fitzgibbons RJ Jr, Camps J, Cornet DA, et al. Laparoscopic inguinal herniorrhaphy. Results of a multicenter trial[J]. Ann Surg, 1995, 221(1): 3-13.
[4]
Lau H, Lee F. Seroma following endoscopic extraperitonealinguinal hernioplasty[J]. Surg Endosc, 2003, 17(11): 1773-1777.
[5]
Reddy VM, Sutton CD, Bloxham L, et al. Laparoscopic repair of direct inguinal hernia: a new technique that reduces the development of postoperative seroma[J]. Hernia, 2007, 11(5): 393-396.
[6]
Kockerling F, Bittnerz R, Adolf D, et al. Seroma following transabdominal preperitoneal patch plasty(TAPP): incidence, risk factors, and preventive measures[J]. Surg Endo, 2018, 32(5): 2222-2231.
[7]
Ramshaw B, Shuler FW, Jones HB, et al. Laparoscopic inguinal hernia repair: lessons learned after 1224 consecutive cases[J]. 2001, 15(1): 50-54.
[8]
Schwab JR, Beaird DA, Ramshaw BJ, et al. After 10 years and 1903 inguinal hernias, what is the outcome for the laparoscopic repair?[J]. 2002, 16(8): 1201-1206.
[9]
Park A, Birch DW, Lovrics P. Laparoscopic and open incisional hernia repair: a comparison study[J]. Surgery, 1998, 124(4): 816-821; discussion 821-822.
[10]
Berney CR. The Endoloop technique for the primary closure of direct inguinal hernia defect during the endoscopic totally extraperitoneal approach[J]. Hernia. 2012, 16(3): 301-305.
[11]
Li J, Zhang W. Closure of a direct inguinal hernia defect in laparoscopic repair with barbed suture: a simple method to prevent seroma formation?[J]. Surg Endosc, 2018, 32(2): 1082-1086.
[12]
Bittner R, Arregui ME, Bisgaard T, et al. Guidelines for laparoscopic(TAPP) and endoscopic(TEP) treatment of inguinal Hernia[International Endohernia Society(IEHS)][J]. Surg Endosc, 2011, 25(9): 2773-2843.
[13]
Wantz GE. Complications of inguinal hernia repair[J]. Surg Clin North Am, 1984 64(2): 287-298.
[14]
Simons MP, Aufenacker T, Bay-Nilsen M, et al. European Hernia Society guidelines on the treatment of inguinal hernia in adult patients[J]. Hernia, 2009, 13(4): 343-403.
[15]
Daes J. Endoscopic repair of large inguinoscrotal hernias: management of the distal sac to avoid seroma formation[J]. Hernia. 2014, 18(1): 119-122.
[16]
Li J, Zhang W, J zl. Prevention of seroma formation after laparoscopic inguinoscrotal indirect hernia repair by a new surgical technique-a preliminary report. International Journal of Abdominal Wall and Hernia Surgery[J]. Int J Abdom Wall Hernia Surg 2018, 1: 55-59.
[17]
Ismail M, Garg M, Rajagopal M, et al. Impact of closed-suction drain in preperitoneal space on the incidence of seroma formation after laparoscopic total extraperitoneal inguinal hernia repair[J]. Surg Laparosc Endosc Percutan Tech, 2009, 19(3): 263-266.
[18]
Gao D, Wei S, Zhai C, et al. Clinical research of preperitoneal drainage after endoscopic totally extraperitoneal inguinal hernia repair[J]. Hernia, 2015, 19(5): 789-794.
[19]
Fan JKM, Liu J, Chen K, et al. Preperitoneal closed-system suction drainage after totally extraperitoneal hernioplasty in the prevention of early seroma formation: a prospective double-blind randomised controlled trial[J]. Hernia, 2018, 22(3): 455-465.
[20]
Aeberhard P, Klaiber C, Meyenberg A, et al. Prospective audit of laparoscopic totally extraperitoneal inguinal hernia repair: a multicenter study of the Swiss Association for Laparoscopic and Thoracoscopic Surgery(SALTC)[J]. Surg Endosc, 1999, 13(11): 1115-1120.
[1] 杜晓辉, 崔建新. 腹腔镜右半结肠癌D3根治术淋巴结清扫范围与策略[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 5-8.
[2] 周岩冰, 刘晓东. 腹腔镜右半结肠癌D3根治术消化道吻合重建方式的选择[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 9-13.
[3] 张焱辉, 张蛟, 朱志贤. 留置肛管在中低位直肠癌新辅助放化疗后腹腔镜TME术中的临床研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 25-28.
[4] 王春荣, 陈姜, 喻晨. 循Glisson蒂鞘外解剖、Laennec膜入路腹腔镜解剖性左半肝切除术临床应用[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 37-40.
[5] 李晓玉, 江庆, 汤海琴, 罗静枝. 围手术期综合管理对胆总管结石并急性胆管炎患者ERCP +LC术后心肌损伤的影响研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 57-60.
[6] 甄子铂, 刘金虎. 基于列线图模型探究静脉全身麻醉腹腔镜胆囊切除术患者术后肠道功能紊乱的影响因素[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 61-65.
[7] 逄世江, 黄艳艳, 朱冠烈. 改良π形吻合在腹腔镜全胃切除消化道重建中的安全性和有效性研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 66-69.
[8] 曹迪, 张玉茹. 经腹腔镜生物补片修补直肠癌根治术后盆底疝1例[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 115-116.
[9] 李凯, 陈淋, 向涵, 苏怀东, 张伟. 一种U型记忆合金线在经脐单孔腹腔镜阑尾切除术中的临床应用[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 15-15.
[10] 李三祥, 李佳, 刘俊峰, 吕东晨, 方晖东, 谭朝晖, 刘杰, 潘佐, 乔建坤. 基于CT影像的三维重建成像技术在腹腔镜大肾上腺肿瘤切除术中的应用[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(06): 570-574.
[11] 赵佳晖, 王永兴, 彭涛, 李明川, 魏德超, 韩毅力, 侯铸, 姜永光, 罗勇. 后腹腔镜根治性肾切除手术时间延长和术中出血量增多的影响因素分析[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(06): 575-580.
[12] 林文斌, 郑泽源, 郑文能, 郁毅刚. 外伤性脾破裂腹腔镜脾切除术患者中转开腹风险预测模型构建[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 619-623.
[13] 牛朝, 李波, 张万福, 靳文帝, 王春晓, 李晓刚. 腹腔镜袖状胃切除联合胆囊切除治疗肥胖合并胆囊结石安全性和疗效[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 635-639.
[14] 张文华, 陶焠, 胡添松. 不同部位外生型肝癌临床病理特点及其对术后肝内复发和预后影响[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 651-655.
[15] 叶文涛, 吴忠均, 廖锐. 癌旁组织ALOX15表达与肝癌根治性切除术后预后的关系[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 708-712.
阅读次数
全文


摘要