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) ›› 2023, Vol. 17 ›› Issue (05) : 539 -543. doi: 10.3877/cma.j.issn.1674-392X.2023.05.009

论著

复发性腹股沟疝的腹腔镜手术策略及疗效观察
蒋正东, 李徐奇, 王曙逢, 魏光兵()   
  1. 710061 西安交通大学第一附属医院普通外科
  • 收稿日期:2023-02-25 出版日期:2023-10-18
  • 通信作者: 魏光兵
  • 基金资助:
    国家自然科学基金青年项目(81902967); 吴阶平医学基金会临床科研专项资助基金(320.6750.2022-7-2)

Laparoscopic surgery strategy for recurrent inguinal hernia and the observation of therapeutic effects

Zhengdong Jiang, Xuqi Li, Shufeng Wang, Guangbing Wei()   

  1. Department of General Surgery, the First Affiliated Hospital of Xi'an Jiaotong University Xi'an, 710061, Shaanxi, China
  • Received:2023-02-25 Published:2023-10-18
  • Corresponding author: Guangbing Wei
引用本文:

蒋正东, 李徐奇, 王曙逢, 魏光兵. 复发性腹股沟疝的腹腔镜手术策略及疗效观察[J/OL]. 中华疝和腹壁外科杂志(电子版), 2023, 17(05): 539-543.

Zhengdong Jiang, Xuqi Li, Shufeng Wang, Guangbing Wei. Laparoscopic surgery strategy for recurrent inguinal hernia and the observation of therapeutic effects[J/OL]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2023, 17(05): 539-543.

目的

探索分析复发性腹股沟疝患者的再次手术方法,总结临床治疗经验及腹腔镜手术的要点。

方法

回顾分析2019—2021年西安交通大学第一附属医院收治的52例复发性腹股沟疝患者的临床资料,依据初次手术方式的不同分为:开放疝修补术后复发、腹腔镜疝修补术后复发及其他治疗后复发。

结果

根据患者初次手术方式的不同,对52例复发疝患者实施个体化复发疝手术策略,其中42例行腹腔镜疝修补术,10例行开放疝修补术,手术时间为(65.1±19.8)min,住院时间为(5.9±1.9)d。其中行开放疝修补术1例患者于术后1年内复发,2例术后出现症状性血清肿。

结论

腹腔镜可以更好地探查复发疝情况,其治疗安全有效,对于绝大多数复发腹股沟疝患者在有经验的疝中心行腔镜手术是安全有效的手术方法。

Objective

To explore and analyze the reoperation methods for patients with recurrent inguinal hernia and summarize clinical treatment experience and key points of laparoscopic surgery.

Methods

We conducted a retrospective analysis of the clinical data of 52 patients with recurrent inguinal hernia admitted to the First Affiliated Hospital of Xi'an Jiaotong University from 2019 to 2021. According to the different initial surgical methods, they were divided into three categories: recurrence after open hernia repair, recurrence after laparoscopic hernia repair, and recurrence after other treatments.

Results

According to the different initial surgical methods of the patients, a personalized strategy for recurrent hernia surgery was implemented in 52 patients, including 42 cases of laparoscopic hernia repair and 10 cases of open hernia repair. The surgical time was (65.1±19.8) minutes, and the hospital stay was (5.9±1.9) days. One patient who underwent open hernia repair experienced recurrence within one year after surgery, and two patients developed symptomatic seroma after surgery.

Conclusion

Laparoscopy can better explore the situation of recurrent inguinal hernia, and its treatment is safe and effective. For the vast majority of recurrent inguinal hernia patients, laparoscopic surgery at experienced hernia centers is a safe and effective surgical method.

图1 疝囊高位结扎术后复发患者经腹腹膜前手术注:1A疝囊高位结扎术后复发患者内环口;1B内环口粘连紧密分离困难;1C、1D"T"形切开腹膜。
图2 平片+网塞疝修补术后复发患者经腹腹膜前手术注:2A平片+网塞疝修补术后复发患者内环口;2B内环口粘连紧密分离困难;2C、2D切开部分补片充分游离腹膜前间隙。
图3 M-K修补术后复发患者经腹腹膜前手术注:3A M-K修补术后复发患者内环口;3B充分游离腹膜前间隙;3C缝合疝囊及内环口;3D妥善固定补片。
图4 硬化剂注射术后复发患者经腹腹膜前手术注:4A硬化剂注射术后复发患者内环口;4B膀胱前间隙粘连紧密,游离困难;4C依据疝环大小适当裁剪补片;4D妥善固定补片。
表1 复发腹股沟疝患者的基本资料及手术疗效观察[例(%)]
[1]
Keller JJ, Muo CH, Lan YC, et al. A nation-wide population-based study of inguinal hernia repair incidence and age-stratified recurrence in an Asian population[J]. Hernia, 2015, 19(5): 735-740.
[2]
Shakil A, Aparicio K, Barta E, et al. Inguinal Hernias: Diagnosis and Management[J]. Am Fam Physician, 2020, 102(8): 487-492.
[3]
王明刚, 申英末, 陈杰, 等. 腹腔镜经腹腔腹膜前疝修补技术治疗复发性腹股沟疝的疗效观察[J]. 中华医学杂志, 2016, 96(20): 1588-1590.
[4]
屈坤鹏, 张琪, 成晓舟, 等. 成人腹股沟嵌顿疝的临床治疗策略[J]. 中华消化外科杂志, 2021, 20(7): 779-784.
[5]
Fernandez-Alberti J, Iriarte F, Croceri RE, et al. Laparoscopic treatment(reTAPP) for recurrence after laparoscopic inguinal hernia repair[J]. Hernia, 2021, 25(5): 1301-1307.
[6]
唐健雄, 孟云潇. 疝与腹壁外科发展方向的思路拓展[J]. 中华消化外科杂志, 2021, 20(7): 760-763.
[7]
Kohno S, Hasegawa T, Aoki H, et al. Analysis of risk factors for surgical site infection and postoperative recurrence following inguinal and femoral hernia surgery in adults[J]. Asian J Surg, 2022, 45(4):1001-1006.
[8]
Ramsay G, Scott NW, Jansen JO. A 19 year population-based cohort study analysing reoperation for recurrence following laparoscopic and open inguinal hernia repairs[J]. Hernia, 2020, 24(4): 793-800.
[9]
Schjoth-Iversen L, Refsum A, Brudvik KW. Factors associated with hernia recurrence after laparoscopic total extraperitoneal repair for inguinal hernia: a 2-year prospective cohort study[J]. Hernia, 2017, 21(5): 729-735.
[10]
Niebuhr H, Kockerling F. Surgical risk factors for recurrence in inguinal hernia repair-a review of the literature[J]. Innov Surg Sci, 2017, 2(2): 53-59.
[11]
Siddaiah-Subramanya M, Ashrafi D, Memon B, et al. Causes of recurrence in laparoscopic inguinal hernia repair[J]. Hernia, 2018, 22(6): 975-986.
[12]
Tatarian T, Nie L, McPartland C, et al. Comparative perioperative and 5-year outcomes of robotic and laparoscopic or open inguinal hernia repair: a study of 153, 727 patients in the state of New York[J]. Surg Endosc, 2021, 35(12): 7209-7218.
[13]
Kehlet H, Bay-Nielsen M. Local anaesthesia as a risk factor for recurrence after groin hernia repair[J]. Hernia, 2008, 12(5): 507-509.
[14]
Lydeking L, Johansen N, Oehlenschlager J, et al. Re-recurrence and pain 12 years after laparoscopic transabdominal preperitoneal(TAPP) or Lichtenstein's repair for a recurrent inguinal hernia: a multi-centre single-blinded randomised clinical trial[J]. Hernia, 2020, 24(4): 787-792.
[15]
Kilda A, Berzanskis M, Lukosiute-Urboniene A, et al. High recurrence rate of children's inguinal hernia after percutaneous internal ring suturing: a single-center study[J]. Hernia, 2021, 25(3): 797-801.
[16]
李芳, 王峻峰. 腹腔镜经腹腹膜前疝修补术治疗腹股沟复发疝的临床疗效及安全性[J/OL]. 中华疝和腹壁外科杂志(电子版), 2021, 15(4): 421-429.
[17]
汤睿, 吴卫东, 柳楠. 复发性腹股沟疝的手术治疗[J/OL]. 中华疝和腹壁外科杂志(电子版), 2020, 14(1): 9-13.
[18]
王曦滔, 黄耿文, 申鼎成, 等. 复发性腹股沟疝的手术策略及近期疗效[J]. 中华胃肠外科杂志, 2018, 21(7): 761-765.
[19]
贾高磊, 刘岩, 田志龙, 等. 成人腹股沟复发疝行腹腔镜经腹膜前间隙修补术疗效分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2020, 14(6): 613-617.
[20]
徐时, 俞晓峰. 两种手术方式治疗网塞型补片修补术后复发腹股沟疝患者的临床疗效[J/OL]. 中华疝和腹壁外科杂志(电子版), 2020, 14(2): 164-167.
[21]
Haggerty S, Forester B, Hall T, et al. Laparoscopic repair of recurrent inguinal hernia offers similar outcomes and quality of life to primary laparoscopic repair[J]. Hernia, 2021, 25(1): 165-172.
[1] 李国新, 陈新华. 全腹腔镜下全胃切除术食管空肠吻合的临床研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 1-4.
[2] 李子禹, 卢信星, 李双喜, 陕飞. 食管胃结合部腺癌腹腔镜手术重建方式的选择[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 5-8.
[3] 李乐平, 张荣华, 商亮. 腹腔镜食管胃结合部腺癌根治淋巴结清扫策略[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 9-12.
[4] 陈方鹏, 杨大伟, 金从稳. 腹腔镜近端胃癌切除术联合改良食管胃吻合术重建His角对术后反流性食管炎的效果研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 15-18.
[5] 许杰, 李亚俊, 韩军伟. 两种入路下腹腔镜根治性全胃切除术治疗超重胃癌的效果比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 19-22.
[6] 李刘庆, 陈小翔, 吕成余. 全腹腔镜与腹腔镜辅助远端胃癌根治术治疗进展期胃癌的近中期随访比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 23-26.
[7] 刘世君, 马杰, 师鲁静. 胃癌完整系膜切除术+标准D2根治术治疗进展期胃癌的近中期随访研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 27-30.
[8] 任佳, 马胜辉, 王馨, 石秀霞, 蔡淑云. 腹腔镜全胃切除、间置空肠代胃术的临床观察[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 31-34.
[9] 赵丽霞, 王春霞, 陈一锋, 胡东平, 张维胜, 王涛, 张洪来. 内脏型肥胖对腹腔镜直肠癌根治术后早期并发症的影响[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 35-39.
[10] 王庆亮, 党兮, 师凯, 刘波. 腹腔镜联合胆道子镜经胆囊管胆总管探查取石术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 313-313.
[11] 杨建辉, 段文斌, 马忠志, 卿宇豪. 腹腔镜下脾部分切除术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 314-314.
[12] 叶劲松, 刘驳强, 柳胜君, 吴浩然. 腹腔镜肝Ⅶ+Ⅷ段背侧段切除[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 315-315.
[13] 郭兵, 王万里, 何凯, 黄汉生. 腹腔镜下肝门部胆管癌根治术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(01): 143-143.
[14] 李凯, 陈淋, 苏怀东, 向涵, 张伟. 超微创器械在改良单孔腹腔镜巨大肝囊肿开窗引流及胆囊切除中的应用[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(01): 144-144.
[15] 魏丽霞, 张安澜, 周宝勇, 李明. 腹腔镜下Ⅲb型肝门部胆管癌根治术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(01): 145-145.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?