目的 研究完全腹膜外腹腔镜腹股沟疝修补术对睾丸血流灌注及体积的影响。 方法 2009年7月－2011年5月，对62例行完全腹膜外腹腔镜单侧腹股沟疝修补术男性患者进行自身前后对照研究，比较术前、术后患侧睾丸的睾丸动脉（TA）、睾丸包膜动脉（CA）、睾丸内动脉（ITA）血流参数[收缩期峰值血流速度（PSV）、舒张未期血流速度（EDV）及血管阻力指数（RI）]、睾丸体积（TV）及血清睾酮的变化情况。 结果 患者获随访7～24个月，平均15.6个月，无复发患者。术前及术后3、6个月时患侧TV分别为（9.91 ± 3.72）、（10.23 ± 4.18）和（10.16 ± 3.94）cm3，同期血浆睾酮水平分别为（544.25 ± 123.72）、（532.89 ± 145.66）和（565.65 ± 138.13）μg/L，手术前后比较患侧TV（F=1.350，P=0.263）、血浆睾酮水平（F=1.673，P=0.192）无统计学意义，血浆睾酮水平均在正常范围内。术后3、6个月患侧TA、CA和ITA的EDV明显高于术前，RI较术前明显降低，差异均有统计学意义（P＜0.05）；PSV与术前比较差异无统计学意义（P＞0.05）。术后3个月患侧睾丸各动脉PSV、EDV、RI与术后6个月比较差异无统计学意义（P＞0.05）。 结论 完全腹膜外腹腔镜腹股沟疝修补术后患侧睾丸血流灌注情况可能会有所改善，不影响TV及血清睾酮水平。
Objective To evaluate the clinical application of the different operative approaches of the laparoscopicrepair of inguinal hernia and provide a more rational and scientific choice for the surgeon. Methods The strict inclusion and exclusion criteria were set up. All the randomized controlled trials （RCT） about laparoscopic transabdominal preperi-toneal （TAPP） and totally extraperitoneal （TEP） approaches of laparoscopic inguinal hernia repair were collected. Meta an-alysis was performed according to the recommendation by the Cochrane handbook. Results Seven RCTs including 552 patients were analyzed， who were divided into TAPP group （n=302） and TEP group （n=250）. Compared with TAPP group， there were no significant differences of the operation time〔WMD=8.49， 95% CI （-1.37， 18.35）， P=0.09〕， postoperative hospitalization〔SMD=0.11， 95% CI （-0.12， 0.34）， P=0.34〕， postoperative recurrence rate 〔OR=1.37， 95% CI （0.36， 5.20）， P=0.64〕， and complications （incision infection， urinary retention） 〔Incision infection：OR=4.27， 95% CI （0.85， 21.57）， P=0.08；Urinary retention：OR=0.61， 95% CI （0.21， 1.78）， P=0.36〕in the TEP group. But the postoperative 24 h pain in the TEP group was significantly milder than that in the TAPP group 〔WMD=0.72， 95% CI （0.58， 0.87）， P＜0.000 01〕. Conclusions The currently available evidence shows that postoperative 24 h pain in the TEP group is more milder than that in the TAPP group. The time of the operation， postoperative hospitalization， postoperative recurrence， and complications are no significant differences between TAPP group and TEP group. Large-scale， high-quality RCTs are still needed to confirm or refuse the available evidence.
目的 探讨采用卵圆钳分离建立腹膜外间隙的腹腔镜完全腹膜外疝修补术（TEP）的临床应用体会和经验。方法 笔者所在医院2007年8月至2011年7月期间在硬膜外麻醉下采用卵圆钳分离建立腹膜外间隙对117例患者行免钉合改良TEP。结果 117例患者中行TEP 114例，中转腹腔镜腹膜前疝修补术（TAPP）3例。手术时间38～196min，平均单侧58.6min，双侧106.5min。住院时间2～10d，平均4.2d。主要并发症为阴囊积液或血清肿11例（9.4％），阴囊积气8例 （6.8％），无其他并发症发生。随访时间12个月，无复发及腹股沟区慢性疼痛等远期并发症发生。结论 卵圆钳分离建立腹膜外间隙的TEP是安全可行和经济实用的。
ObjectiveTo study the efficacy, the operation skills, and the complications of laparoscopic totally extraperitoneal prosthesis (TEP). MethodsThe clinical data of 1 020 patients received TEP from April 2011 to March 2014 were retrospectively analyzed. The oral feeding time, out of bet time, operation time, hospital stay, hospitalization costs, postoperative complications, and so on were recorded. ResultsAmong the 1 020 patients, the types of hernias were 810 indirect inguinal hernias (including unilateral hernia and bilateral hernia), 118 direct inguinal hernias, 24 femoral hernias, and 68 recurrent inguinal hernias. The surgeries were basically successfully completed in all the patients, including 12 cases (both recurrent hernia) of conversion to laparoscopic transabdominal preperitoneal prosthesis (TAPP). All the patients could take food in a day and get out of bed on day 1 after operation. The unilateral operation time was (48±9.8) min, bilateral was (65±8.6) min. The postoperative hospital stay was 0.5-2.0 d, total hospital stay was (3.48±2.40) d, hospitalization costs was (8 958±1 685) yuan. Main complication was 61 (5.98%) cases of seroma, 48 (4.70%) cases of temporary nerve paresthesia, 23 (2.78%) cases of urinary retention, 9 (0.88%) cases of chronic pain, and 5 (0.49%) cases of abdominal artery injury. No incision infection, visceral injury, small intestinal obstruction, and other serious complications happened. No occurrence occurred with following-up for 1 year. Classification of different hernia complications, the statistical analysis showed that the total incidence of complications of the typeⅣwas highest, then which was in sequence of typeⅢ, typeⅡ, typeⅠ(P < 0.001). ConclusionLaparoscopic TEP is a safe, reasonable repair without tension with small incision, lighter abdominal interference, less pain, early return to normal activities, but it is a difficult technology and has a higher cost.
ObjectiveTo compare the efficiency of total extraperitoneal inguinal herniorrhaphy with laparoscopic technique using an innovative self-gripping mesh and polypropylene mesh. MethodsThe clinical data of 142 cases of unilateral inguinal hernia who underwent total extraperitoneal prosthesis (TEP) in our hospital form June 2012 to March 2015 were retrospectively analyzed. the operation type was total extraperitoneal inguinal herniorrhaphy with laparoscopic technique. Depending on the kind of mesh, all patients were divided into two groups from the self-gripping mesh group (n=60) and the polypropylene mesh group (n=82). ResultsThere was no significant difference in the operation time, intraoperative blood loss, hospital stay, and The Visual Analogue Score of post-operative (at 12, 24, 48, and 72 hours after operation) between the 2 groups (P>0.05). On the post-operative complications, there was no significant difference in incidences of total complication, scrotal edema, seroma, bladder injury, vascular injury of abdominal, and urinary reten-tion too (P>0.05). All the patients were followed up for 3-36 months (the median time was 19-month), and no recurrence occurred during the follow-up period. ConclusionInnovative self-gripping mesh is safe and effective, and maybe a good direction of mesh for material development.
ObjectiveTo investigate the clinical characteristics and risk factors of chronic pain after laparoscopic inguinal hernia repair.MethodsThe clinical data of 142 cases underwent laparoscopic inguinal hernia repair from January 2013 to December 2017 in The Second Affiliated Hospital of Xiamen Medical College were retrospectively analyzed.ResultsThe incidence of chronic pain after laparoscopic inguinal hernia repair was 12.7% (18/142), and 83.3% (15/18) of the patients were located in the inguinal region. Univariate analysis showed that postoperative chronic pain rates were higher in patients receiving standard patch, large patch, mechanical fixation patch, and with postoperative complications (P<0.05). Multivariate analysis showed that large patch [OR=1.82, 95% CI was (1.18, 5.36), P=0.023], mechanical fixation patch [OR=1.44, 95% CI was (1.07, 3.62), P=0.039], and postoperative complications [OR=2.53, 95% CI was (1.27, 7.31), P=0.011] were independent risk factors for postoperative chronic pain after laparoscopic inguinal hernia repair.ConclusionThe occurrence of chronic pain after laparoscopic inguinal hernia repair is the result of many factors, especially the complications and patch factors.
ObjectiveTo observe the pathological changes of the peritoneum before and after the total extraperitoneal herniorrhaphy via preperitoneal space approach for incisional hernia in rats, and to explore the effects on the ischemia and necrosis of the peritoneum and its function after the extensive dissociation of the preperitoneal space and the implantation of the patch. MethodsA total of 80 SD rats were randomly divided into normal control group (n=8), hernia model control group (n=8), patch implantation blank control group, and hernia model patch repair group. Eight rats were randomly selected at week 1, 4, 8, and 12 after patch implantation from the patch implantation blank control group and hernia model patch repair group. The normal peritoneum and surrounding tissues were taken from the normal control group, and the peritoneal tissues near the incision were taken from the hernia model control group, patch implantation blank control group, and the hernia model patch repair group. The hematoxylin-eosin staining was performed to observe the pathological changes of the peritoneum. The degrees of inflammatory cell infiltration and fiber hyperplasia among the different groups were compared. Results① Comparison of the degree of inflammatory cell infiltration in the peritoneal tissue, which in the patch implantation blank control group at week 1 and 4 after patch implantation was more severe than the normal control group (P＜0.001, P=0.005) respectively, which at week 8 after patch implantation was alleviated (P=0.021) as compared to the 1st week after patch implantation in the patch implantation blank control group, which had no statistic difference between the patch implantation blank control group and normal control group (P=0.102), which at the 1st week after patch implantation was more severe than hernia model control group (P=0.014), which was alleviated at week 8 and 12 after patch implantation as compared to the 1st week after patch implantation in the hernia model patch repair group (P=0.040, P=0.040), which had no statistic differences between the patch implantation blank control group and the hernia model patch repair group at same time point after patch implantation (P>0.05). ② Comparison of the degree of fiber hyperplasia in the peritoneal tissue, which at week 1, 4, and 12 after patch implantation was more severe (P＜0.001, P=0.003, P＜0.001, respectively) in the patch implantation blank control group as compared with the normal control group; which was alleviated at week 8 after patch implantation as compared to the 1st week after patch implantation in the hernia model patch repair group（P=0.017); which was more severe in the hernia model control group as compared with the normal control group (P=0.012); which had no statistical differences between the hernia model control group and the hernia model patch repair group at different time point (P>0.05); which had no obvious change between-time point in the hernia model patch repair group (P>0.05); which had no statistic differences between the patch implantation blank control group and the hernia model patch repair group at same time point after patch implantation (P>0.05). ConclusionsBased on the experimental results of this study, hernia itself will not stimulate inflammatory cell infiltration and fiber hyperplasia of peritoneal tissue. However, during the process of total extraperitoneal herniorrhaphy via preperitoneal space approach, extensive peritoneal space dissociation and patch implantation will cause peritoneal injury and affect its function. But through the body itself repair, the function caused by peritoneal injury can be fully restored to normal status on the 8th week after patch implantation.