目的

探讨腹腔镜下疝修补术治疗原发性耻骨上疝的可行性及安全性。

方法

回顾性分析2021 年1 月至2024 年1 月解放军第九九一医院普通外科在腹腔镜腹股沟疝修补术中发现的原发性耻骨上疝7 例患者的临床资料。

结果

患者中男性6 例，女性1 例；平均年龄（71.57±9.33）岁；体重指数17.48～24.61 kg/m²，平均（21.75±2.23）kg/m²；所有病例术前均行彩色多普勒超声检查诊断为腹股沟疝，其中左侧疝1 例，该例曾行右侧腹股沟疝修补术；右侧疝6 例，其中1 例曾行右侧腹股沟疝修补术，2 例曾行左侧腹股沟疝修补术，1 例曾行阑尾切除术，1 例曾行右侧腹股沟疝修补术＋阑尾切除术。7 例患者手术均获成功，腹腔镜完全腹膜外疝修补术（TEP）5 例，其中1 例中转行腹腔镜经腹腹膜前疝修补术（TAPP），另外2 例直接行TAPP 手术；术中测量疝环缺损直径平均为（2.0±0.29）cm；术中无肠管、血管、精索、输精管损伤；手术时间平均为（127.14±24.30）min；术中出血量平均为（5.29±2.36）ml。术后无肠梗阻、创面感染、暂时性神经感觉异常、缺血性睾丸炎等并发症。术后住院天数2～4 d，中位住院天数3 d；术后血清肿1 例，经穿刺抽液治愈；全组随访时间2～36 个月，中位时间24 个月，无复发，无慢性疼痛。

结论

腹腔镜下疝修补术是一种安全有效的治疗原发性耻骨上疝的方法。

Objective

To investigate the feasibility and safety of laparoscopic repair for primary suprapubic hernias.

Methods

The clinical data of 7 patients who underwent laparoscopic inguinal hernia repair and diagnosed with primary suprapubic hernias from January 2021 to January 2024 in the Department of General Surgery, the 991st Hospital of Joint Logistic Support Force of PLA were analyzed retrospectively.

Results

There were 6 males and 1 female in the study. Average age was (71.57±9.33)years. Body mass index ranged 17.48～24.61 kg/m², average (21.75±2.23) kg/m². Prior to surgery, all patients were diagnosed as inguinal hernia by color Doppler ultrasonography, including left-sided inguinal hernia in 1 case who had a history of right-sided inguinal hernia repair. There were 6 cases of right-sided inguinal hernia, of which one case had history of right-sided inguinal hernia repair, 2 cases had history of left-sided inguinal hernia repair, 1 case had history of appendectomy and 1 case had history of right-sided inguinal hernia repair and appendectomy. All the 7 patients underwent successful surgery, including 5 cases with laparoscopic totally extra-peritoneal hernia repair (TEP), and 1 of which was converted to laparoscopic trans-abdominal preperitoneal hernia repair (TAPP), the other 2 cases received TAPP. The average defect size was 2.0±0.29cm. No intestinal canal, blood vessel, spermatic cord, or vas deferens damage occurred during operation. The mean operative time was (127.14±24.30) min, the mean intraoperative blood loss was (5.29±2.36) ml. No intestinal obstruction, wound infection, temporary neurological feeling abnormality or ischemic orchitis occurred postoperatively. The postoperative hospital stay was 2-4 days, with a median time of 3 days. Postoperative seroma formation occurred in 1 case, who was cured by puncture and aspiration. All cases were followed up for 2-36 months, with a median time of 24 months. There was no recurrence or chronic pain.

Conclusion

Laparoscopic hernia repair is safe and feasible in the treatment of primary suprapubic hernia.