腹腔镜下耻骨肌孔空间分离对全腹膜外疝修补术患者临床效果分析  

Analysis of clinical effect of laparoscopic separation of pubic skeletal muscle space for patients undergoing totally extraperitoneal hernia repair

作　　者：杨春文 奚海林[2] 周卫华 罗文全 柴磊 Yang Chunwen;Xi Hailin;Zhou Weihua;Luo Wenquan;Chai Lei(Department of Surgery,Hanzhong City Mianxian Hospital,Hanzhong 724200,China;Department of Surgery,Xuzhou Central Hospital,Xuzhou 221006,China)

机构地区：[1]陕西省汉中市勉县医院外科,汉中724200 [2]徐州市中心医院外科,221006

出　　处：《中华普通外科学文献（电子版）》2018年第4期265-268,共4页Chinese Archives of General Surgery(Electronic Edition)

摘　　要：目的研究腹腔镜下耻骨肌孔空间分离在全腹膜外疝修补术(TEP)中的临床疗效。方法选取2015年11月至2017年7月汉中市勉县医院进行TEP手术的90例腹股沟疝患者,按照随机对照表法分为试验组和对照组,各45例。试验组实施腹腔镜下结合耻骨肌孔的空间分离解剖法行TEP,对照组实施单纯腹腔镜TEP,观察并对比两组患者的临床疗效。免疫组织化学SP法分析试验组中基质金属蛋白酶2(MMP-2)组织中的表达和血清中的含量,放射免疫法检测组织中Ⅰ、Ⅲ型胶原含量。结果试验组患者的手术时长、术后的进食时间、术后下床时间和住院时间均低于对照组患者,差异有统计学意义(t=9.012、4.601、12.306、5.235,均P<0.001);试验组术后慢性疼痛、感觉神经异常、阴囊血肿发生率低于对照组,差异有统计学意义(χ~2=2.362、1.523、4.987,P=0.017、0.016、0.041);两组均无切口感染;试验组患者手术疗效为优的百分比和优良率高于对照组,差异有统计学意义(χ~2=4.106,P=0.019)。直疝型MMP-2表达较斜疝型明显增高,差异有统计学意义;与斜疝型相比,直疝型Ⅲ型胶原含量增加,Ⅰ型胶原含量减少,差异有统计学意义(t=5.321、4.936、5.374,P=0.041、0.021、0.031)。结论腹腔镜下观察TEP手术空间解剖结构,在耻骨肌孔区域建立4个空间,临床手术疗效好、恢复快、且术后并发症少,值得广泛推广。MMP-2对成人腹股沟疝患者胶原的降解作用与成人腹股沟疝的形成有关联。Objective To study the clinical efficacy of laparoscopic supraclavicular myofascial space separation in totally extraperitoneal hernia repair(TEP).Methods The ninety patients with inguinal hernia who underwent TEP from November 2015 to July 2017 in Hanzhong City Mianxian Hospital were randomly selected.They were divided into test group and control group according to the random comparison table,with 45 cases in each group.The test group underwent laparoscopic TEP combined with the spatial separation and anatomy of the pubic symphysis of the pubis,while the control group received simple laparoscopic TEP.Immunohistochemical SP method and radioimmunoassay analysis was used to measure matrix metalloproteinase-2(MMP-2)content and expression of serum tissue in the collagen content medium of the test group(divided into direct inguinal hernia group and indirect inguinal hernia group).Results The operation time,eating time,postoperative ambulation time and postoperative hospitalization time after surgery of the test group was lower than the control group,the differences were statistically significant(t=9.012,4.601,12.306,5.235,all P<0.001).The postoperative chronic pain,sensory nerve abnormalities and the incidence of scrotal hematoma in the test group were significantly lower than those in the control group(χ2=2.362,1.523,4.987,P=0.017,0.016,0.041).There was no incision infection in the two groups.The test group had better surgical efficacy rate than the control group,the difference was statistically significant(χ2=4.106,P=0.019).Compared with the indirect hernia group,the expression of MMP-2 and typeⅢcollagen in direct hernia group were significantly higher,the content of the type I collagen in direct hernia group was significantly decreased(t=5.321,4.936,5.374,P=0.041,0.021,0.031).Conclusions TEP shows good curative effect,quick recovery and less postoperative complications of laparoscopic observation in surgical space anatomy to establish four spaces in the pubis muscle area,which is worthy of extensive promotion.T

关 键 词：腹腔镜 耻骨肌孔 空间分离 疝 腹股沟 

分 类 号：R656.2[医药卫生—外科学]