Interpretation of Chinese expert consensus on laparoscopic diagnosis and treatment algorithm for incarcerated inguinal hernia (2024 edition)

doi:10.16139/j.1007-9610.2026.01.07

Abstract

Abstract:

Incarcerated inguinal hernia is a common surgical emergency, traditionally treated primarily with open surgery. In recent years, laparoscopic techniques have gradually gained attention, but there is a lack of relevant consensus in China. This article was based on the pioneering Chinese expert consensus on laparoscopic diagnosis and treatment algorithm for incarcerated hernia (2024 edition), jointly formulated by the Hernia and Abdominal Wall Surgery Group and the Laparoscopic and Endoscopic Surgery Group of the Surgery Branch of the Chinese Medical Association. Combining evidence-based evidence and clinical practice, it further interpreted the scientificity of its methods, organized core opinions, and described the clinical implementation process oriented toward clinical scenarios. The aim was to provide practical solutions for clinical doctors, especially grassroots physicians, offering the most direct scheme support, to enhance the therapeutic outcomes for patients with incarcerated hernia and reduce complications and mortality rates.

Key words: Inguinal hernia, Incarceration, Laparoscopic surgery, Hernia repair, Expert consensus interpretation

CLC Number:

R656.2⁺1

DONG Ruizhao, ZHUANG Qiulin, DING Zuoyou, XU Jing, YANG Ziang. Interpretation of Chinese expert consensus on laparoscopic diagnosis and treatment algorithm for incarcerated inguinal hernia (2024 edition)[J]. Journal of Surgery Concepts & Practice, 2026, 31(01): 36-44.

Figures/Tables 2

Tab 1

Summary of recommendations

序号	意见内容	证据等级	投票同意率	循证依据和论点拆解
1	术前尽量行超声和（或）腹部计算机断层扫描（computed tomography, CT）	3级	94.40%	腹部超声和CT检查可有效鉴别嵌顿疝合并急腹症，评估嵌顿疝的解剖位置和疝内容物情况，包括合并肠梗阻以及肠管缺血坏死情况；影像学诊断和腹腔镜探查延误可能导致肠坏死切除率增加15%及并发症发生率和病死率增加[2, 7]。
2	尽量行腹腔镜探查	3级	96.30%	腹腔镜探查可进一步除外其他合并急腹症，评估嵌顿疝的解剖位置和疝内容物情况，并明确嵌顿肠管有无坏死、穿孔等[8-12]；影像学诊断和腹腔镜探查延误可能导致肠坏死切除率增加15%及并发症发生率和病死率增加[2, 7]。
3	优先经腹腹膜前入路疝修补术(transabdominal preperitoneal, TAPP)入路探查	3级	100%	TAPP入路有利于腹腔探查，术者有较多时间观察嵌顿肠管的血供情况；经疝囊腹腔镜探查常用于开放手术，但腹腔镜下观察范围广泛、安全高效；WSES指南推荐诊断性腹腔镜探查评估肠管活性[13-17]。
4	急诊腹腔镜适应证、手术时机与开放手术一致	3级	98.10%	成人嵌顿疝诊断明确、术前准备完善、无肠管明确坏死穿孔征象者，可选择腹腔镜手术；有明确腹膜炎和腹腔感染、肠绞窄者、可能需肠切除者不推荐腹腔镜手术；WSES指南推荐肠管嵌顿应立即手术；大型回顾性研究显示早期手术降低病死率和并发症；高龄、基础条件差者可仅解决急症情况，二期疝修补；腹腔镜手术在住院时间、术后并发症发生、切口感染、术后疼痛方面优于开放手术[13, 18-21]。
5	术者需具有丰富的择期腹腔镜手术经验和开放组织修补手术能力	5级	100%（腔镜经验）/88.8%（开放能力）	腹腔镜手术技术难度较高，需丰富经验保障；国际指南建议根据术者经验个体化选择[18, 22-23]。
6	腹腔镜松解，未显著增加肠管和血管、神经损伤风险	4级	77.60%	“外推内拉”是常用方式，疝环切开位置需安全（如斜疝外上方切开）；疝囊腔内注水辅助复位安全可行；无法复位可转开放手术[19, 24]。
7	拟腹腔镜修补时，优先TAPP修补	3级	99.10%	急诊TAPP布孔、放置补片方法和择期手术相同；目前无RCT对比TAPP与完全腹膜外入路(totally extraperitoneal approach, TEP approach)疝修补术优劣；有低级别回顾性队列显示TAPP在特定病例中有优势；TAPP有利于腹腔探查和评估肠管活性，WSES亦推荐探查；TAPP复发率和并发症与择期手术相当；与开放手术相比，TAPP可降低肠管切除率；急诊TAPP使用聚丙烯补片术后并发症发生率和复发率较低；TEP可隔离腹腔降低感染风险，但需经验丰富（有经验者TEP与TAPP差异无统计学意义）；TEP开放手术中转率较高，无法直接探查腹腔，且复发率和并发症发生率高于择期手术[8-9, 13, 23, 25-33]。
8	以切口等级决定补片使用： Ⅰ级推荐使用； Ⅱ级和Ⅲ级推荐个体化使用； Ⅳ级推荐不使用	均3级	97.2%（Ⅰ级）； 40.2%使用&30.8%不确定（Ⅱ/Ⅲ级）； 89.7%（Ⅳ级）	《国际成人腹股沟疝管理指南》支持本推荐意见，并指出若合并对侧非嵌顿疝，可同期腹腔镜下修补；较多报道显示放置补片不显著增加感染风险；WSES推荐无绞窄/肠切除时放置合成补片，有绞窄/肠切除时选择性放置；嵌顿疝使用合成补片安全，即便存在肠坏死，复发率和感染率也可接受；生物补片用于污染术野，其循证证据主要来源嵌顿性腹壁疝急诊手术或污染手术；交联或非交联生物补片可个体化使用；国际指南按切口等级选择[3, 13, 18, 33-43]。
9	首选轻量大网孔补片	3级	80.40%	补片类型以单股编织轻量大网孔补片为主，安全有效，且即使肠坏死、肠切除，复发率和感染率可接受[38, 44]。
10	以术野污染程度个体化放置补片间隙引流	5级	70.1%放置/22.4%不确定	补片间隙放置密闭式负压引流装置可降低补片感染风险[42]。
11	术前做好中转开放手术预案	5级	97.20%	中转开放手术指征包括疝囊颈松解困难、肠坏死需切除、粘连致密分离困难、合并其他疾病需切除肠管、肠梗阻导致空间不足[45]。
12	腹腔镜对肠管活性的评估可减少不必要的肠管切除	3级	89.70%	评估内容包括肠管穿孔、颜色、蠕动、系膜搏动等；肠坏死分级评分可指导判断；嵌顿>6 h是肠切除重要影响因素；有条件可使用吲哚菁绿荧光评估肠管活性；腹腔镜充分评估可减少不必要切除[46-49]。
13	嵌顿疝腹腔镜诊治流程应遵循国内腹股沟疝诊疗质量控制标准	5级	96.30%	流程包括明确手术指征、入路选择、肠管评估、疝修补方式选择；TAPP/TEP探查后根据肠管坏死和污染程度决定补片放置[50]。
14	围术期使用抗菌药物	3级	89.70%	预防性或治疗性使用抗菌药物，取决于术野污染程度[23, 51]。
15	充分评估静脉血栓栓塞(venous thromboembolis,VTE)风险并采取相应措施	3级	93.50%	嵌顿疝病人VTE风险增高，围术期常规评估中高风险病人采用机械或药物预防，完整方案细节在所标注参考文献中[52-57]。
16	围术期遵循急腹症镇痛治疗原则	5级	83.20%	术前诊断明确后酌情镇痛，术后常规镇痛，但对迟发性肠坏死风险大者慎用 [58-59]。
17	迟发性坏死或穿孔时，是否取补片应个体化决策	5级	80.40%	术中评估不足将导致迟发性坏死；若怀疑时应再次探查行肠切除；补片无感染依据，可予以保留。
18	腹腔镜手术降低手术部位感染(surgical site infection, SSI)发生风险	3级	83.20%	SSI危险因素包括CT检查显示积液、心率>90次/min、体质量指数(body mass index, BMI)>35 kg/m²、嵌顿时间长、肠梗阻；腹腔镜手术降低切口感染风险；冲洗和引流降低补片/腹腔感染机会[60-63]。
19	腹腔镜手术复发率与开放手术相当	3级	95.30%	腹腔镜补片修补降低复发率和再手术率；未放置补片者复发率较高，建议3个月后修补；腹腔镜与开放手术复发率差异无统计学意义[35, 64-65]

Tab 1

Fig 1

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