腹腔镜联合负压引流治疗Ⅰ型巨大腹股沟阴囊疝疗效分析

doi:10.3877/cma.j.issn.1674-392X.2023.02.007

目的

探讨腹腔镜经腹腹膜前疝修补术（TAPP）联合负压引流治疗Ⅰ型巨大腹股沟阴囊疝（GISH）的安全性和有效性。

方法

回顾性分析2017年1月至2020年12月在重庆医科大学附属第二医院接受TAPP手术联合负压引流治疗的37例Ⅰ型GISH患者的临床资料，记录术中疝类型、手术时间、术中出血量、术后并发症及复发率等结果。

结果

37例Ⅰ型GISH患者均顺利完成TAPP手术，术中经阴囊途径于腹膜前间隙留置负压引流管，所有患者无新增辅助穿刺孔及中转开腹。手术时间（147.3±21.8）min，疝环大小（48.6±11.5）mm，术中出血量（31.9±17.3）ml，术后引流时间（7.2±2.3）d，引流量（820.8±138.2）ml,术中无腹腔脏器副损伤。术后3例患者出现轻微并发症，1例为术中损伤腹壁下动脉，1例为术后症状性血清肿，1例为脐部穿刺点感染。出院后平均随访时间13.7个月，无疝复发或补片感染病例。

结论

TAPP联合负压引流是一种微创治疗Ⅰ型GISH安全而有效的手术方法，但还需要前瞻性、大样本、长期随访结果予以证实。

关键词: 阴囊疝, 疝，腹股沟, 腹腔镜, 疝修补术, 负压引流, 血清肿

Objective

To investigate the safety and effectiveness of the transabdominal preperitoneal (TAPP) approach with negative pressure drainage in type Ⅰ giant inguinal scrotal hernia (GISH).

Methods

From January 2017 to December 2020, 37 patients who underwent TAPP with negative pressure drainage for type Ⅰ GISH in our hospital were reviewed and retrospectively analyzed. The types of hernia, operative time, intraoperative blood loss, postoperative complications and recurrence rate were recorded.

Results

All the patients were successfully repaired through the TAPP approach with negative pressure drainage with no additional auxiliary puncture ports or laparotomies. The operative time was (147.3±21.8) minutes. The orifice size of the hernia was (48.6±11.5) mm and the intraoperative blood loss was (31.9±17.3) ml. After operations, the drainage time was (7.2±2.3) days, and the volume of drainage in each patient was (820.8±138.2) ml. No injury of celiac organs occurred during operation. However, minor complications occurred in 3 cases. In one case, the inferior epigastric artery was injured in the operation. A seroma formed in one patient which occurred 2 days after removal of the drainage tube. One patient developed an infection at the site of the umbilical puncture, which was treated by changing the dressing. The mean follow-up was 13.7 months and there was no recurrence or mesh infection during the period.

Conclusion

TAPP combined with negative pressure drainage is a safe and effective approach for type Ⅰ GISH with low operative complications. Due to the small sample size of this study, it still required prospective, large-sample and long-term follow-up results to confirm.

Key words: Scrotal hernia, Hernia, inguinal, Laparoscopic, Herniorrhaphy, Negative pressure drainage, Seroma

表1 巨大腹股沟阴囊疝患者基本特征[例（%）]

基本特征	数值
年龄(岁,±s)	66.8±11.3
体质量指数(kg/m²,±s)	25.4± 3.1
<25	20(54.1)
≥25,<30	14(37.8)
≥30,<35	3( 8.1)
吸烟	3( 8.1)
合并症
高血压	13(35.1)
糖尿病	5(13.5)
慢性阻塞性肺疾病	3( 8.1)
阻塞性睡眠呼吸暂停	1( 2.7)
前列腺增生	11(29.7)
使用抗血小板药物	8(21.6)
使用抗凝药物	4(10.8)
美国麻醉医师分级
Ⅱ级	25(67.6)
Ⅲ级	12(32.4)

表1 巨大腹股沟阴囊疝患者基本特征[例（%）]

基本特征	数值
年龄(岁,±s)	66.8±11.3
体质量指数(kg/m²,±s)	25.4± 3.1
<25	20(54.1)
≥25,<30	14(37.8)
≥30,<35	3( 8.1)
吸烟	3( 8.1)
合并症
高血压	13(35.1)
糖尿病	5(13.5)
慢性阻塞性肺疾病	3( 8.1)
阻塞性睡眠呼吸暂停	1( 2.7)
前列腺增生	11(29.7)
使用抗血小板药物	8(21.6)
使用抗凝药物	4(10.8)
美国麻醉医师分级
Ⅱ级	25(67.6)
Ⅲ级	12(32.4)

图1 巨大腹股沟阴囊疝分型图示注：A线为大腿内侧中线；B线为大腿内侧中线与髌骨上缘线的中点连线；C线为髌骨上缘线。

图2 经腹腹膜前疝修补术术中及术后情况注：2A疝环处环形切开腹膜（箭头处），充分游离腹膜前间隙；2B经阴囊于腹膜前间隙补片前方放置负压引流管（箭头处）；2C完整缝合腹膜；2D维持负压引流，同时腹壁及腹股沟区加压包扎。

图3 巨大腹股沟阴囊疝患者腹股沟区手术前后状态对比注：3A腹股沟区术前状态；3B腹股沟区术后状态（B1正位图，B2侧位图）。

[1]	Prochotsky A, Dolak S, Minarovjech V, et al. Giant inguinoscrotal hernia repair[J]. Bratisl Lek Listy, 2017, 118(8): 472-478.
[2]	Sahsamanis G, Samaras S, Basios A, et al. Treatment of a half century year old giant inguinoscrotal hernia. A case report[J]. Int J Surg Case Rep, 2016, 25: 51-54.
[3]	Sanford Z, Weltz AS, Singh D, et al. Minimally Invasive Multidisciplinary Approach to Chronic Giant Inguinoscrotal Hernias[J]. Surg Innov, 2019, 26(4): 427-431.
[4]	钟文毅, 郭国城, 吴演清. 改良处理远端疝囊预防巨大腹股沟斜疝术后并发症临床研究[J/OL]. 中华疝和腹壁外科杂志(电子版), 2016, 10(3): 203-206.
[5]	Staubitz JI, Gassmann P, Kauff DW, et al. Surgical treatment strategies for giant inguinoscrotal hernia-A case report with review of the literature[J]. BMC Surg, 2017, 17(1): 1-7.
[6]	Trakarnsagna A, Chinswangwatanakul V, Methasate A, et al. Giant inguinal hernia: report of a case and reviews of surgical techniques[J]. Int J Surg Case Rep, 2014, 5(11): 868-872.
[7]	Miserez M, Peeters E, Aufenacker T, et al. Update with level 1 studies of the European Hernia Society guidelines on the treatment of inguinal hernia in adult patients[J]. Hernia, 2014, 18(2): 151-163.
[8]	HerniaSurge Group. International guidelines for groin hernia management[J]. Hernia, 2018, 22(1): 1-165.
[9]	Cavalli M, Biondi A, Bruni PG, et al. Giant inguinal hernia: the challenging hug technique[J]. Hernia, 2015, 19(5): 775-783.
[10]	余卓敏, 侯泽辉, 宗振, 等. 联合微创治疗慢性巨大腹股沟疝[J]. 中华胃肠外科杂志, 2020, 23(4): 1216-1219.
[11]	Fujinaka R, Urade T, Fukuoka E, et al. Laparoscopic transabdominal preperitoneal approach for giant inguinal hernias[J]. Asian J Surg, 2019, 42(1): 414-419.
[12]	Anand M, Hajong R, Naku N, et al. Giant Inguinal Herniae Managed by Primary Repair: A Case Series[J]. J Clin Diagnostic Res, 2017, 11(2): PR01-2.
[13]	Siow SL, Mahendran HA, Hardin M, et al. Laparoscopic transabdominal approach and its modified technique for incarcerated scrotal hernias[J]. Asian J Surg, 2013, 36(2): 64-68.
[14]	Gonzalez-Urquijo M, Estrada-Cortinas OJ, Rodarte-Shade M, et al. Preoperative progressive pneumoperitoneum: The answer for treating giant inguinal hernias while avoiding morbidities?[J]. Hernia, 2020, 24(4): 781-786.
[15]	Tang FX, Zong Z, Xu JB, et al. Combination of Preoperative Progressive Pneumoperitoneum and Botulinum Toxin A Enables the Laparoscopic Transabdominal Preperitoneal Approach for Repairing Giant Inguinoscrotal Hernias[J]. J Laparoendosc Adv Surg Tech A, 2020, 30(3): 260-266.
[16]	Leibl BJ, Schmedt CG, Kraft K, et al. Scrotal hernias: A contraindication for an endoscopic procedure? Results of a single-institution experience in transabdominal preperitoneal repair[J]. Surg Endosc, 2000, 14(3): 289-292.
[17]	Misra MC, Bhowate PD, Bansal VK, et al. Massive scrotal hernias: Problems and solutions[J]. J Laparoendosc Adv Surg Tech, 2009, 19(1): 19-22.
[18]	Bierca J, Kosim A, Kołodziejczak M, et al. Effectiveness of Lichtenstein repairs in planned treatment of giant inguinal hernia own experience[J]. Videosurgery Other Miniinvasive Tech, 2013, 8(1): 36-42.
[19]	Bansal V, Prakash O, Krishna A, et al. Large scrotal hernias: Totally extraperitoneal(TEP) or transabdominal preperitoneal(TAPP) repair? [J]. International Journal of Abdominal Wall and Hernia Surgery, 2020, 3(4): 138-143.
[20]	Patel V, Gupta T, El-Medani F, et al. Laparoscopic Inguinal Hernia Repair: Transabdominal Preperitoneal or Totally Extraperitoneal? Results of a 14-year Prospective Study[J]. Chirurgia(Bucur), 2020, 115(5): 600-608.

[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]	汪帮琦, 陈波特, 林浩坚, 许晖阳, 王镇伟, 袁雪峰, 林康健, 邱晓拂. 经腹入路3D腹腔镜联合输尿管硬镜同期处理肾盂输尿管连接部梗阻并肾盏结石的应用[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(06): 597-600.
[13]	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.
[14]	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.
[15]	张继新, 胡军红, 谢爽, 武祖印, 张春旭. 经阴道单孔腹腔镜阑尾切除术可行性及近期疗效分析[J]. 中华结直肠疾病电子杂志, 2023, 12(06): 460-465.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

Analysis of clinical effect of laparoscopic transabdominal preperitoneal approach with negative pressure drainage for type Ⅰ giant inguinal scrotal hernia

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

Analysis of clinical effect of laparoscopic transabdominal preperitoneal approach with negative pressure drainage for type Ⅰ giant inguinal scrotal hernia