23例患者采用单切口腹腔镜手术行腹股沟疝完全腹膜外修补术。

Single-incision Laparoscopic surgery for total extraperitoneal repair of inguinal hernias in 23 patients.

作者信息

Surgit Onder

机构信息

Department of General Surgery, Fatih University School of Medicine, Ankara, Turkey.

出版信息

Surg Laparosc Endosc Percutan Tech. 2010 Apr;20(2):114-8. doi: 10.1097/SLE.0b013e3181d848c3.

DOI:10.1097/SLE.0b013e3181d848c3

PMID:20393339

Abstract

BACKGROUND

Laparoscopic surgery has long been the treatment of choice for recurrent or bilateral hernias, and for unilateral hernias when the patient does not want to undergo open surgery. Each laparoscopic incision or trocar presents risks for hemorrhage, organ injury, incisional hernia, and poor cosmetic outcome. For this reason, single-incision laparoscopic surgery (SILS) is being increasingly used to treat a variety of conditions. The aim of this study was to evaluate the use of SILS for total extraperitoneal (TEP) repair of hernias in the largest series performed to date.

PATIENTS AND METHODS

During the period from June to September 2009, 23 consecutive patients underwent SILS for TEP repair of inguinal hernias. SILS was performed under general anesthesia, with the use of a single access port device and articulating as well as standard laparoscopic instruments. Demographic and clinical data, intraoperative findings, and postoperative course were recorded.

RESULTS

In the 23 patients (mean age 48.4 y; 18 males and 5 females), a total of 27 hernias were repaired. Unilateral hernias were present in 19 patients and bilateral hernias in four. Of the unilateral hernias, 11 were on the right and 8 on the left. Indirect hernias occurred in 15 patients, direct hernias in 7 patients, and a direct+indirect hernia was seen in 1 patient. All hernias were repaired successfully with SILS except in 1 patient. In this patient, due to the large size of the hernia and the presence of adhesions, the procedure was converted to a standard laparoscopic TEP repair. Mean operative times for unilateral and bilateral hernias were 48.4 minutes (range: 32-62 min) and 96.7 minutes (range: 85-120 min), respectively. None of the patients experienced intraoperative or postoperative complications. Mean hospital stay was 1.17 days.

CONCLUSIONS

The use of SILS for TEP repair of hernias provides excellent cosmetic results, and articulating instruments seem to be useful for this procedure.

摘要

背景

长期以来，腹腔镜手术一直是复发性或双侧疝以及患者不愿接受开放手术时单侧疝的首选治疗方法。每个腹腔镜切口或套管针都有出血、器官损伤、切口疝和美容效果不佳的风险。因此，单切口腹腔镜手术（SILS）越来越多地用于治疗各种病症。本研究的目的是在迄今为止最大的系列研究中评估SILS在疝的完全腹膜外（TEP）修补术中的应用。

患者与方法

在2009年6月至9月期间，连续23例患者接受了SILS进行腹股沟疝的TEP修补术。SILS在全身麻醉下进行，使用单个接入端口装置以及关节式和标准腹腔镜器械。记录人口统计学和临床数据、术中发现及术后病程。

结果

23例患者（平均年龄48.4岁；男性18例，女性5例）共修补27处疝。19例为单侧疝，4例为双侧疝。单侧疝中，右侧11例，左侧8例。15例为间接疝，7例为直接疝，1例为直疝+斜疝。除1例患者外，所有疝均通过SILS成功修补。在该患者中，由于疝的尺寸较大且存在粘连，手术转为标准腹腔镜TEP修补术。单侧和双侧疝的平均手术时间分别为48.4分钟（范围：32 - 62分钟）和96.7分钟（范围：85 - 120分钟）。所有患者均未发生术中或术后并发症。平均住院时间为1.17天。