摘要
目的探讨不同次序腹腔镜胆囊切除与无张力疝修补联合手术的安全性与可行性。方法回顾性分析南京鼓楼医院集团宿迁市人民医院2008年1月至2011年12月收治慢性胆囊炎并腹股沟疝患者24例,根据先行腹腔镜胆囊切除(LC)与先行普理灵疝装置(PHS)无张力疝修补,分为FLC组(11例)和FPHS组(13例),均于全麻下实施手术。结果二组患者手术时间、VAS评分、平均住院日、平均重返工作时间、平均住院费用差异均无统计学意义(P>0.05),FLC组平均麻醉时间为(128±10)min,FPHS组为(118±10)min,二组差异有统计学意义(t=-2.393,P=0.026)。FLC组胆囊破裂2例,穿刺孔切口红肿1例,换药处理后好转。FPHS组胆囊破裂1例;穿刺孔切口肿1例,换药后好转;阴囊血肿1例,经抽吸积血好转。全组无一例发生胆管损伤、胆漏,随访3个月至3年无因手术部位感染取出内置物和顽固性腹股沟区疼痛患者,无复发。结论严格掌握手术指征及术中技巧,适当预防性应用抗生素,同期联合腹腔镜胆囊切除与无张力疝修补联合手术是安全可行的,推荐先行腹腔镜胆囊切除术。
Objective To investigate the safety and feasibility of the combined laparoscopic cholecystectomy （LC） with tension-free hernia repair in different sequences. Methods A total of 24 patients with chronic cholecystitis complicated with inguinal hernia from Suqian People＇s Hospital during January 2008 to December 2011 were retrospectively analyzed,based on the first LC and tension-free hernia repair with prolene hernia system （PHS）. The FLC group （n = 11 ） and FPHS group （n = 13） were included, both in the surgery under general anesthesia. Results The operative time, VAS score, the mean hospitalization stay, the mean time for recovery, and the mean cost of hospitalization had no significant differences. The mean anesthesia time were 118.2 minutes in the FLC group and 128.1 minutes in the FPHS group with significant differences （t = - 2.393,P = 0.026）. Two cases of gallbladder rupture during operation, and 1 case of puncture incision swelling were improved after the dressing processing in FLC group. One case of gallbladder was found with rupture during operation in the FPHS group;one case of puncture incision swelling was improved after dressing;one case of scrotal hematoma was improved with blood clots by suction. There was no bile duct inju- ry or bile leakage. After a follow-up of 3 months to 3 years, no surgical site infection was required to remove the mesh. No intractable groin pain and hernia recurrence were found. Conclusions With strict indication controls for surgical skills, and appropriate preventive actions with antibiotics, laparoscopic cholecystectomy combined with hernia repair surgery is safe and feasible in the synchronization while the LC was preferred.
出处
《中华疝和腹壁外科杂志（电子版）》
2013年第1期19-21,共3页
Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition)
关键词
疝
腹股沟
胆囊炎
胆囊切除术
腹腔镜
无张力
疝修补术
Hernia, inguinal
Cholecystitis
Cholecystectomy, Laparoscopic
Tension-free
Herniorrhaphy
