• 安徽省合肥市第二人民醫(yī)院普外科(安徽合肥 230011);

目的  比較腹腔鏡全腹膜外(TEP)與經(jīng)腹腹膜前(TAPP)腹股溝疝修補術的可行性、安全性及有效性。
方法  回顧性分析2010年3月至2013年10月期間于筆者所在醫(yī)院行腹腔鏡TEP疝修補術(TEP組)和腹腔鏡TAPP疝修補術(TAPP組)的95例腹股溝疝患者的臨床資料和手術資料,比較TEP組和TAPP組患者的手術時間、術中出血量、術后住院時間、手術費用、術后并發(fā)癥發(fā)生情況等。
結果  所有患者的手術均獲成功,無中轉開放手術病例。TEP組與TAPP組患者的手術時間〔(65±16)min比(68±17)min〕、術中出血量〔(7.0±1.2) mL比(8.0±1.4) mL〕、術后疼痛分數(shù) 〔(2.0±1.1)分比(1.8±1.1)分〕、術后住院時間〔(3.1±1.4) d比(3.3±1.2) d〕及恢復正常活動時間〔(4.2±1.0) d比(4.5±1.2) d〕比較差異均無統(tǒng)計學意義(P>0.05);TEP組和TAPP組的手術費用分別為(8 033±536)元和(9 632±643)元,TAPP組較高(P=0.007)。術后發(fā)生并發(fā)癥6例(6.3%,6/95),2組各3例,包括陰囊血(清)腫3例、暫時性感覺神經(jīng)障礙1例,尿潴留2例,2組并發(fā)癥發(fā)生率比較差異也無統(tǒng)計學意義(P=1.000)。所有患者均獲訪,隨訪時間為1~35個月、(20.0±10.2)個月,無復發(fā)及慢性疼痛發(fā)生。
結論  TEP與TAPP疝修補術均是可行、安全及有效的術式,各有其優(yōu)缺點,兩者在手術并發(fā)癥方面無明顯差別。

引用本文: 江鳴,姜友,汪杰,姚寶忠,陳宏存,張軍,李文波,李良. 腹腔鏡全腹膜外與經(jīng)腹腹膜前腹股溝疝修補術的臨床對比研究△. 中國普外基礎與臨床雜志, 2013, 20(12): 1391-1395. doi: 復制

1. Lichtenstein IL, Shulman AG, Amid PK, et al. The tension-free hernioplasty[J]. Am J Surg, 1989, 157(2):188-193.
2. Schultz LS, Graber JN, Pietrafitta J, et al. Early results with laparoscopic inguinal herniorrhaphy are promising[J]. Clin LaserMon, 1990, 8(7):103-105.
3. 中華醫(yī)學會外科學會疝和腹壁外科學組. 成人腹股溝疝、股疝和腹部手術切口疝手術治療方案(2003年修訂稿)[J]. 中華外科雜志, 2004, 42(14):834-835.
4. McKernan JB, Laws HL. Laparoscopic repair of inguinal hernias using a totally extraperitoneal prosthetic approach[J]. Surg End-osc, 1993, 7(1):26-28.
5. Dion YM, Morin J. Laparoscopic inguinal herniorrhaphy[J]. Can J Surg, 1992, 35(2):209-212.
6. Morales-Conde S, Socas M, Fingerhut A. Endoscopic surgeons’preferences for inguinal hernia repair:TEP, TAPP, or OPEN[J].Surg Endosc, 2012, 26(9):2639-2643.
7. 李健文, 王映昌, 張凌捷, 等. 腹股溝疝腹腔鏡手術在我國逐步推廣的可行性探討[J]. 外科理論與實踐, 2010, 15(6):611-615.
8. Gass M, Banz VM, Rosella L, et al. TAPP or TEP? Population-based analysis of prospective data on 4 552 patients undergoing endoscopic inguinal hernia repair[J]. World J Surg, 2012, 36(12):2782-2786.
9. McCormack K, Wake B, Perez J, et al. Laparoscopic surgery for inguinal hernia repair:systematic review of effectiveness and economic evaluation[J]. Health Technol Assess, 2005, 9(14):1-203.
10. Kapiris SA, Brough WA, Royston CM, et al. Laparoscopic transa-bdominal preperitoneal (TAPP) hernia repair. A 7-year two-center experience in 3 017 patients[J]. Surg Endosc, 2001, 15(9):972-975.
11. Campanelli G, Pettinari D, Cavalli M, et al. Inguinal herniarecurrence:classification and approach[J]. J Minim Access Surg, 2006, 2(3):147-150.
12. Bittner R, Schmedt CG, Schwarz J, et al. Laparoscopic transperitoneal procedure for routine repair of groin hernia[J]. Br J Surg, 2002, 89(8):1062-1066.
13. Leibl BJ, Schmedt CG, Kraft K, et al. Scrotal hernias:a contr-aindication for an endoscopic procedure? Results of a single-insti-tution experience in transabdominal preperitoneal repair[J]. SurgEndosc, 2000, 14(3):289-292.
14. Bittner R, Arregui ME, Bisgaard T, et al. Guidelines for laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal hernia 〔International Endohernia Society (IEHS)〕[J]. Surg Endosc, 2011, 25(9):2773-2843.
15. Chowbey PK, Bandyopadhyay SK, Sharma A, et al. Recurrent hernia following endoscopic total extraperitoneal repair[J]. J Laparoendosc Adv Surg Tech A, 2003, 13(1):21-25.
16. Mirilas P, Colborn GL, McClusky DA 3rd, et al. The history of anatomy and surgery of the preperitoneal space[J]. Arch Surg, 2005, 140(1):90-94.
17. Zanghì A, Di Vita M, Lo Menzo E, et al. Multicentric evaluationby Verbal Rate Scale and EuroQoL-5D of early and late post-oper-ative pain after TAPP and TEP procedures with mechanical fixationfor bilateral inguinal hernias[J]. Ann Ital Chir, 2011, 82(6):437-442.
18. Krishna A, Misra MC, Bansal VK, et al. Laparoscopic inguinal hernia repair:transabdominal preperitoneal (TAPP) versus totally extraperitoneal (TEP) approach:a prospective randomized contro-lled trial[J]. Surg Endosc, 2012, 26(3):639-649.
19. Bracale U, Melillo P, Pignata G, et al. Which is the best laparos-copic approach for inguinal hernia repair:TEP or TAPP? A syste-matic review of the literature with a network meta-analysis[J]. Surg Endosc, 2012, 26(12):3355-3366.
20. Robert JJ, Greenburg AG著, 馬頌章譯[M]. 第5版. 北京:人民衛(wèi)生出版社, 2003:293-299.
21. Garg P, Rajagopal M, Varghese V, et al. Laparoscopic total extraperitoneal inguinal hernia repair with nonfixation of the mesh for 1 692 hernias[J]. Surg Endosc, 2009, 23(6):1241-1245.
22. Olmi S, Erba L, Bertolini A, et al. Fibrin glue for mesh fixationin laparoscopic transabdominal preperitoneal (TAPP) hernia repair:indications, technique, and outcomes[J]. Surg Endosc, 2006, 20(12):1846-1850.
23. 江鳴, 張軍, 陳宏存, 等. 肌恥骨孔在腹腔鏡腹股溝疝修補術中的臨床意義[J]. 中華疝和腹壁外科雜志:電子版, 2012, 6(4):950-954.
24. 曾輝, 鄭本波, 李鋒, 等. 腹膜前間隙在腹腔鏡TAPP及TEP疝修補術中的重要作用(附66例報道)[J]. 中國普外基礎與臨床雜志, 2012, 19(9):980-983.
25. 林志華. 腹腔鏡腹股溝疝修補術經(jīng)腹腔腹膜前與完全腹膜外手術入路療效的meta分析[J]. 中國普外基礎與臨床雜志, 2013, 20(5):517-524.
26. 臧潞, 李健文, 毛志海, 等. 腹腔鏡完全腹膜外與經(jīng)腹腹膜前疝修補術臨床對照分析[J]. 中國實用外科雜志, 2005, 25(10):611-613.
  1. 1. Lichtenstein IL, Shulman AG, Amid PK, et al. The tension-free hernioplasty[J]. Am J Surg, 1989, 157(2):188-193.
  2. 2. Schultz LS, Graber JN, Pietrafitta J, et al. Early results with laparoscopic inguinal herniorrhaphy are promising[J]. Clin LaserMon, 1990, 8(7):103-105.
  3. 3. 中華醫(yī)學會外科學會疝和腹壁外科學組. 成人腹股溝疝、股疝和腹部手術切口疝手術治療方案(2003年修訂稿)[J]. 中華外科雜志, 2004, 42(14):834-835.
  4. 4. McKernan JB, Laws HL. Laparoscopic repair of inguinal hernias using a totally extraperitoneal prosthetic approach[J]. Surg End-osc, 1993, 7(1):26-28.
  5. 5. Dion YM, Morin J. Laparoscopic inguinal herniorrhaphy[J]. Can J Surg, 1992, 35(2):209-212.
  6. 6. Morales-Conde S, Socas M, Fingerhut A. Endoscopic surgeons’preferences for inguinal hernia repair:TEP, TAPP, or OPEN[J].Surg Endosc, 2012, 26(9):2639-2643.
  7. 7. 李健文, 王映昌, 張凌捷, 等. 腹股溝疝腹腔鏡手術在我國逐步推廣的可行性探討[J]. 外科理論與實踐, 2010, 15(6):611-615.
  8. 8. Gass M, Banz VM, Rosella L, et al. TAPP or TEP? Population-based analysis of prospective data on 4 552 patients undergoing endoscopic inguinal hernia repair[J]. World J Surg, 2012, 36(12):2782-2786.
  9. 9. McCormack K, Wake B, Perez J, et al. Laparoscopic surgery for inguinal hernia repair:systematic review of effectiveness and economic evaluation[J]. Health Technol Assess, 2005, 9(14):1-203.
  10. 10. Kapiris SA, Brough WA, Royston CM, et al. Laparoscopic transa-bdominal preperitoneal (TAPP) hernia repair. A 7-year two-center experience in 3 017 patients[J]. Surg Endosc, 2001, 15(9):972-975.
  11. 11. Campanelli G, Pettinari D, Cavalli M, et al. Inguinal herniarecurrence:classification and approach[J]. J Minim Access Surg, 2006, 2(3):147-150.
  12. 12. Bittner R, Schmedt CG, Schwarz J, et al. Laparoscopic transperitoneal procedure for routine repair of groin hernia[J]. Br J Surg, 2002, 89(8):1062-1066.
  13. 13. Leibl BJ, Schmedt CG, Kraft K, et al. Scrotal hernias:a contr-aindication for an endoscopic procedure? Results of a single-insti-tution experience in transabdominal preperitoneal repair[J]. SurgEndosc, 2000, 14(3):289-292.
  14. 14. Bittner R, Arregui ME, Bisgaard T, et al. Guidelines for laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal hernia 〔International Endohernia Society (IEHS)〕[J]. Surg Endosc, 2011, 25(9):2773-2843.
  15. 15. Chowbey PK, Bandyopadhyay SK, Sharma A, et al. Recurrent hernia following endoscopic total extraperitoneal repair[J]. J Laparoendosc Adv Surg Tech A, 2003, 13(1):21-25.
  16. 16. Mirilas P, Colborn GL, McClusky DA 3rd, et al. The history of anatomy and surgery of the preperitoneal space[J]. Arch Surg, 2005, 140(1):90-94.
  17. 17. Zanghì A, Di Vita M, Lo Menzo E, et al. Multicentric evaluationby Verbal Rate Scale and EuroQoL-5D of early and late post-oper-ative pain after TAPP and TEP procedures with mechanical fixationfor bilateral inguinal hernias[J]. Ann Ital Chir, 2011, 82(6):437-442.
  18. 18. Krishna A, Misra MC, Bansal VK, et al. Laparoscopic inguinal hernia repair:transabdominal preperitoneal (TAPP) versus totally extraperitoneal (TEP) approach:a prospective randomized contro-lled trial[J]. Surg Endosc, 2012, 26(3):639-649.
  19. 19. Bracale U, Melillo P, Pignata G, et al. Which is the best laparos-copic approach for inguinal hernia repair:TEP or TAPP? A syste-matic review of the literature with a network meta-analysis[J]. Surg Endosc, 2012, 26(12):3355-3366.
  20. 20. Robert JJ, Greenburg AG著, 馬頌章譯[M]. 第5版. 北京:人民衛(wèi)生出版社, 2003:293-299.
  21. 21. Garg P, Rajagopal M, Varghese V, et al. Laparoscopic total extraperitoneal inguinal hernia repair with nonfixation of the mesh for 1 692 hernias[J]. Surg Endosc, 2009, 23(6):1241-1245.
  22. 22. Olmi S, Erba L, Bertolini A, et al. Fibrin glue for mesh fixationin laparoscopic transabdominal preperitoneal (TAPP) hernia repair:indications, technique, and outcomes[J]. Surg Endosc, 2006, 20(12):1846-1850.
  23. 23. 江鳴, 張軍, 陳宏存, 等. 肌恥骨孔在腹腔鏡腹股溝疝修補術中的臨床意義[J]. 中華疝和腹壁外科雜志:電子版, 2012, 6(4):950-954.
  24. 24. 曾輝, 鄭本波, 李鋒, 等. 腹膜前間隙在腹腔鏡TAPP及TEP疝修補術中的重要作用(附66例報道)[J]. 中國普外基礎與臨床雜志, 2012, 19(9):980-983.
  25. 25. 林志華. 腹腔鏡腹股溝疝修補術經(jīng)腹腔腹膜前與完全腹膜外手術入路療效的meta分析[J]. 中國普外基礎與臨床雜志, 2013, 20(5):517-524.
  26. 26. 臧潞, 李健文, 毛志海, 等. 腹腔鏡完全腹膜外與經(jīng)腹腹膜前疝修補術臨床對照分析[J]. 中國實用外科雜志, 2005, 25(10):611-613.