TEP的手术步骤和规范要求.pdfVIP

TEP的手术步骤和规范要求 Totally extraperitoneal herniorrhaphy 李健文 上海市微创外科临床医学中心 上海交通大学医学院附属瑞金医院普外科 1 一、麻醉和体位 麻醉： 建议全身麻醉 [1] [2] 也有区域性麻醉 和局麻 的报道 体位： 头低脚高10~15度平卧位。 [1] Sung TY, Kim MS, Cho CK. Clinical effects of intrathecalfentanyl on shoulder tip pain in TEP under spinal anaesthesia: A double-blind, prospective, randomized controlled trial. J Int Med Res. 2013, 41(4): 1160-1170 [2] Edelman DS, Misiakos EP, Moses K. Extraperitoneal laparoscopic hernia repair with local anesthesia. Surg Endosc. 2001, 15(9):976-80 二、手术室布局 - 术者位于患侧的对侧进行操作 - 助手位于患侧或头侧持镜 - 监视器置于手术台下方正中 三、第一套管的置入 - 开放式方法 - 脐孔下0.5-1.0cm处行小切口 - 切开白线，向两侧牵开腹直肌 - 进入腹直肌背侧与后鞘的间隙 - 置入10-12mm套管 注意事项： - 不能直接在脐孔处切开白线 - 不能切开腹直肌后鞘 4 四、腹膜前间隙的初步建立 球囊分离法[1] 耻骨上穿刺法[2] 手指分离法[3] 直接镜推法[4] [1] McKernan JB, Laws HL. Laparoscopic repair of inguinal hernias using a totally extraperitoneal prosthetic approach. Surg Endosc, 1993, 7(1):26-28 [2] Tetik C, Arregui ME, Dulucq JL et al. Complications and recurrences associated with laparoscopic repair of groin hernias. A muti-institutional analysis. Surg Endosc, 1994, 8(11):1316-1322 [3] Bringman Sven, Ek Asa, Haglind Eva, et al. Is a dessection Ballon beneficial in bilateral totally extraperitoneal endoscopic hernioplasty? A randomized prospective multicenter study. Surg Laparo Endosc, 2001, 11(5): 22-326 [4] Misra MC, Kumar S, Bansal VK, et al. TEP mesh repair of inguinal hernia in the developing world: comparison of low-cost indigenous balloon dissection versus direct telescopic dissection: a prospective randomized controlled study. Surg Endosc. 2008;22(9):1947-58