主动疝囊切开技术在腹腔镜完全腹膜外疝修补术中的临床应用及疗效观察  

Clinical application and observation of active hernia sac incision during totally extraperitoneal

作　　者：朱凯 姚磊 闵凯[2] Zhu Kai;Yao Lei;Ming Kai(Department of General Surgery,Affiliated Tianyou Hospital,Wuhan University of Science&Technology,Hubei Wuhan 430064,China;Department of Hernia&Abdominal Surgery,First Municipal Hospital,Hubei Wuhan 430022,China)

机构地区：[1]武汉科技大学附属天佑医院普外科,湖北武汉430064 [2]武汉市第一医院疝和腹壁外科中心,湖北武汉430022

出　　处：《腹部外科》2021年第4期297-300,共4页Journal of Abdominal Surgery

摘　　要：目的在掌握常规腹腔镜完全腹膜外疝修补术(totally extraperitoneal,TEP)的基础上,研究在术中主动切开斜疝疝囊治疗腹股沟斜疝的临床安全性及有效性。方法回顾性分析2017年3月至2019年3月武汉科技大学附属天佑医院普外科收治的280例成人单侧斜疝病人临床资料,按手术方式的不同分为对照组(140例)和观察组(140例),观察组行术中主动切开斜疝疝囊TEP治疗,对照组行常规TEP治疗,比较两组手术时间(切皮至缝合完毕)、术中出血量、术中副损伤、术中中转率、术后并发症、住院时间、复发率7项指标。结果280例病人均手术顺利,无中途中转开放手术。观察组手术时间为(42.8±10.5)min,短于对照组手术时间[(48.5±13.4)min],差异有统计学意义(t=4.456,P<0.05);术中出血量观察组为(13.9±4.3)mL,少于对照组的(24.8±7.4)mL,差异有统计学意义(t=8.915,P<0.05);观察组术中无输精管及血管损伤情况,优于对照组,差异均有统计学意义(P<0.05);观察组术后并发症发生率(0.71%,1/140)明显低于对照组(3.57%,5/140);术后12 h视觉模拟量表(VAS)疼痛评分、住院时间、复发率差异均无统计学意义。结论TEP中主动切开斜疝疝囊,能在直视下剥离疝囊,直视下精索去腹膜化,不增加手术时间,减少副损伤、术中出血及术后并发症,是一种安全、有效的手术方式。Objective To explore the clinical safety and efficacy of intraoperative active incision of hernia sac for indirect inguinal hernia on the basis of mastering conventional totally extraperitoneal(TEP).Methods From March 2017 to March 2019,280 patients with indirect inguinal hernia were recruited and divided into experiment and control groups according to different operative procedures(n=140 each).The experiment group underwent intraoperative active incision of hernia sac during TEP while control group TEP alone.Two groups were compared with regards to operative duration(skin incision to suturing),intraoperative blood loss,intraoperative collateral injury,intraoperative conversion rate,postoperative complications,mean hospital stay and recurrence rate.Results All operations were successfully performed without converting into open surgery.Operative duration of observation group was shorter than that of control group[(42.8±10.5)min vs.(48.5±13.4)min].The difference was statistically significant(t=4.456,P<0.05);intraoperative blood loss of observation group was less than that of control group[(13.9±4.3)mL vs.(24.8±7.4)mL].The difference was statistically significant(t=8.915,P<0.05);no vasectomy or vascular injury occurred in observation group and it was better than control group.The differences were statistically significant(P<0.05);The incidence of postoperative complications was significantly lower in observation group than that in control group(0.71%vs.3.57%).No significant difference existed in postoperative 12 hVAS pain score,mean hospital stay or recurrence rate.Conclusion While performing intraoperative active incision of hernia sac during TEP,hernia sac may be removed under direct vision and spermatic cord peritonized under direct vision.It can shorten operative duration,avoid collateral damage,minimize intraoperative bleeding and lower postoperative complications.The procedure is both safe and efficacious.

关 键 词：主动疝囊切开 腹腔镜完全腹膜外疝修补术 腹股沟疝 疗效 

分 类 号：R656.21[医药卫生—外科学]