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目的比较不同路径的前列腺癌根治术腹股沟疝发病率,探讨腹腔镜无张力疝修补术治疗前列腺癌根治术后腹股沟疝的临床疗效和安全性。方法回顾性分析2007年11月—2014年7月泌尿外科收治的行腹腔镜下前列腺癌根治术的患者312例,其中223例行经腹腔路径手术,89例行经腹膜前路径手术,术后随访3个月~2年,观察有无腹股沟疝的发生。若在随访期内发生腹股沟疝,预约患者返院以行腹腔镜下腹股沟疝无张力修补术。记录手术时间、引流管引流时间、住院时间以及所有的围手术期并发症,并对患者进行为期1年的随访,以观察有无腹股沟疝的复发。结果经腹膜前路径、经腹腔路径的前列腺癌根治患者分别有3例、10例腹股沟疝发生。经腹腔路径中,实施双侧淋巴结清扫、未实施双侧淋巴结清扫的分别有8例、2例腹股沟疝发生;13例发生腹股沟疝的患者均接受腹腔镜下无张力补片修补术,平均手术时间28 min(15~50 min),术中无输血、中转开放手术病例。术后未出现并发症,腹腔引流管留置1~3 d,平均住院时间5 d(3~7 d)。术后随访1~12个月,平均10个月,未见腹股沟疝复发。结论腹股沟疝是腹腔镜前列腺癌根治术重要的并发症之一,根治手术的入路、是否行双侧淋巴结清扫并非是腹股沟疝发生的影响因素;腹腔镜下疝无张力修补术是治疗术后腹股沟疝的一种安全有效的微创治疗方法,远期疗效有待进一步随访观察。
Objective To compare the incidence of inguinal hernia in radical prostatectomy with different pathways and to explore the clinical efficacy and safety of laparoscopic tension-free hernia repair for inguinal hernia after radical prostatectomy. Methods A retrospective analysis of 312 patients undergoing laparoscopic radical prostatectomy from November 2007 to July 2014 in Urology was performed. Among them, 223 patients underwent peritoneal surgery and 89 patients underwent preperitoneal surgery. Follow-up 3 months to 2 years, observe the occurrence of inguinal hernia. If inguinal hernia occurs during the follow-up period, the patient is scheduled to return to the hospital for laparoscopic inguinal hernia tension-free repair. The operation time, drainage time of drainage tube, length of hospital stay and all perioperative complications were recorded. Patients were followed up for 1 year to observe the recurrence of inguinal hernia. Results In the preperitoneal route, 3 patients underwent radical prostatectomy and 10 patients underwent inguinal hernia respectively. In the abdominal path, bilateral lymph node dissection was performed without bilateral lymph node dissection in 8 cases and 2 cases with inguinal hernia respectively. Thirteen patients with inguinal hernia underwent laparoscopic tension-free patch repair. The mean operation Time of 28 min (15 ~ 50 min), intraoperative blood transfusion, transit open surgery cases. No postoperative complications were found. The abdominal drainage tube was placed for 1-3 days, and the average hospital stay was 5 days (3-7 days). Follow-up 1 to 12 months after surgery, an average of 10 months, no recurrence of inguinal hernia. Conclusions Inguinal hernia is one of the most important complication of laparoscopic radical prostatectomy. Radical surgery is not the influencing factor of inguinal hernia after laparoscopic lymph node dissection. Laparoscopic hernia tension-free repair is the treatment of postoperative A safe and effective minimally invasive treatment of inguinal hernia, long-term efficacy needs further follow-up observation.