Department of Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine and Shanghai Minimally Invasive Surgery Center, Shanghai, China.
J Am Coll Surg. 2013 Feb;216(2):258-65. doi: 10.1016/j.jamcollsurg.2012.10.020.
Our objective was to investigate the feasibility of laparoscopic inguinal hernia repair during its developmental phases in China.
The clinical data of 2,056 patients (2,473 hernias) who underwent laparoscopic inguinal hernia repair at Shanghai Minimally Invasive Surgery Center between January 2001 and December 2011 were analyzed retrospectively. The operation priority was used to divide the patients into 7 groups for analysis of the learning curve.
There were 1,005 transabdominal preperitoneal patch plastic repairs (TAPP), 1,458 total extraperitoneal repairs (TEP), and 10 intraperitoneal onlay mesh repairs performed on 874, 1,175, and 7 patients, respectively. Median follow-up period was 60 months. The operation time and postoperative hospital stay for TEP were considerably shorter than those for TAPP. The complication rate for TEP, especially seroma, was considerably lower. Transabdominal preperitoneal patch plastic repair was performed in 81.4% of the recurrent inguinal hernias. Seven patients underwent unilateral intraperitoneal onlay mesh repair and 3 others underwent unilateral intraperitoneal onlay mesh repair and TAPP on the opposite. Most of patients with grade I and II hernias underwent TEP. The learning curve has demonstrated that more obstacles occurred in the earlier phase of the laparoscopic inguinal hernia repair training, supported by findings such as fewer cases performed annually, longer operation time, and higher incidence of complications and recurrence. These findings have improved as experience is accumulated through more operations. In addition, the ratios of TEP to TAPP and mesh nonfixation to fixation also evolved throughout the course of the study.
Laparoscopic inguinal hernia repair is a feasible technique that can be popularized in China.
本研究旨在探讨腹腔镜腹股沟疝修补术在中国发展阶段的可行性。
回顾性分析 2001 年 1 月至 2011 年 12 月期间在上海微创外科中心接受腹腔镜腹股沟疝修补术的 2056 例（2473 例疝）患者的临床资料。根据手术优先级将患者分为 7 组进行分析，以研究学习曲线。
共进行了 1005 例经腹腹膜前补片修补术（TAPP）、1458 例完全腹膜外修补术（TEP）和 10 例腹膜内补片修补术，分别对 874 例、1175 例和 7 例患者进行了手术。中位随访时间为 60 个月。TEP 的手术时间和术后住院时间明显短于 TAPP。TEP 的并发症发生率，特别是血清肿的发生率明显较低。TAPP 用于治疗 81.4%的复发性腹股沟疝。7 例患者接受了单侧腹膜内补片修补术，另外 3 例患者对侧同时接受了单侧腹膜内补片修补术和 TAPP。大多数 I 级和 II 级疝患者接受了 TEP。学习曲线表明，腹腔镜腹股沟疝修补术培训的早期阶段遇到了更多的障碍，例如每年手术量较少、手术时间较长、并发症和复发发生率较高等。随着手术经验的积累，这些情况得到了改善。此外，TEP 与 TAPP 的比例以及补片固定与非固定的比例在整个研究过程中也发生了变化。
腹腔镜腹股沟疝修补术是一种可行的技术，在中国可以得到推广。
