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中华疝和腹壁外科杂志(电子版) ›› 2022, Vol. 16 ›› Issue (05) : 608 -610. doi: 10.3877/cma.j.issn.1674-392X.2022.05.026

病例报告

腹腔镜经腹腹膜前疝修补术后并发肠梗阻二例并文献复习
孙明明1, 韩富华1, 高林1, 胡根1, 黄建明1, 邵国益1,†()   
  1. 1. 214400　江苏省，东南大学附属江阴市人民医院胃肠外科
  • 收稿日期:2022-01-11 出版日期:2022-10-18
  • 通信作者: 邵国益

Intestinal obstruction after laparoscopic trans-abdominal preperitoneal hernia repair (TAPP) : report of 2 cases and literature review

Mingming Sun1, Fuhua Han1, lin Gao1   

  • Received:2022-01-11 Published:2022-10-18
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孙明明, 韩富华, 高林, 胡根, 黄建明, 邵国益. 腹腔镜经腹腹膜前疝修补术后并发肠梗阻二例并文献复习[J]. 中华疝和腹壁外科杂志(电子版), 2022, 16(05): 608-610.

Mingming Sun, Fuhua Han, lin Gao. Intestinal obstruction after laparoscopic trans-abdominal preperitoneal hernia repair (TAPP) : report of 2 cases and literature review[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2022, 16(05): 608-610.

成人腹股沟疝是普通外科常见疾病之一，多见于老年人，发病率男性高于女性。腹壁强度降低，腹内压增高是引起腹股沟疝的主要病因。若不及时治疗，容易引起严重并发症[1]。手术修补是唯一的治愈手段，近年来随着腹腔镜技术的不断成熟，腹腔镜疝修补已成为治疗腹股沟疝的重要手术方式。目前在临床上使用最多的是完全腹膜外疝修补（totally extraperitoneal hernia repair，TEP）和经腹腹膜前疝修补（transabdominal preperitoneal prosthesis，TAPP）两种术式。TEP与TAPP手术原理基本相同，区别在于进入腹膜前间隙的途径：前者完全从腹膜外进入，后者经腹腔进入[2]。有研究[3,4,5]表明，TAPP具有创面小，术后疼痛轻，恢复快等优势，同时可以探查腹腔、处理双侧腹股沟疝，近年来国内开展较多。但因此术式经腹腔，腹膜完整性被破坏，术后肠粘连、腹内疝是其潜在并发症。TAPP术后腹内疝的症状不典型，可表现为腹部饱胀不适、腹痛或恶心呕吐，甚至与饱餐或体位改变有关，容易误诊漏诊。但腹内疝若不及时解除，肠管卡压严重时会出现血运障碍，肠壁缺血绞窄，甚至危及生命，及早地诊断及治疗尤为重要。目前TAPP术后重大并发症的报道较罕见。本文报道2例TAPP术后腹内疝致肠梗阻病例，并检索相关文献进行探讨总结。

图2 松解受压肠管后可见卡压痕迹
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