弓状线变异在腹腔镜全腹膜外疝修补术中的解剖分析及临床研究  

Anatomical analysis and clinical significance of arcuate line variation in laparoscopic total extraperitoneal hernia repair

作　　者：包小平 马元勇 沈钧华 束翌俊 BAO Xiaoping;MA Yuanyong;SHEN Junhua;SHU Yijun(First Affiliated Hospital of Naval Military Medical University,Shanghai 200093,China)

机构地区：[1]海军军医大学第一附属医院,上海200093 [2]上海市杨浦区控江医院,上海200093 [3]上海交通大学医学院附属新华医院,上海200093

出　　处：《陕西医学杂志》2022年第7期807-810,共4页Shaanxi Medical Journal

基　　金：国家自然科学基金资助项目(82173081)。

摘　　要：目的:探究弓状线变异在腹腔镜全腹膜外疝修补术(TEP)中的解剖分析及临床研究。方法:选取84例腹股沟疝患者,根据患者弓状线位置与标识的不同进行分组,分为高位弓状线组、经典弓状线组、低位弓状线组、多条弓状线组及无弓状线组,比较各组患者的术中及术后康复情况等。结果:通过测量84例患者脐至弓状线的距离,分组情况如下:经典组40例,占比47.62%;高位组7例,占比8.33%;低位组13例,占比15.48%;多条弓状线组21例,占比25%;无弓状线组3例,占比3.57%。比较各组患者之间的手术临床指标发现,在手术难易度以及手术清晰度上,低位组、多条组以及无弓状线组得分均低于经典组(均P<0.05),经典组与高位组相比得分相近(P>0.05);在手术时间上比较,经典组时间最短,无弓状线组所需时间最长(P<0.05)。在腹膜损伤、腹壁下血管损伤、中转手术(开放/TAPP)及血肿上,经典组的发生率低于低位组、多条组及无弓状线组(均P<0.05);高位组在腹壁下血管损伤发生率上最低;在气肿上,经典组发生率高于低位组、多条组及无弓状线组(均P<0.05)。结论:弓状线变异不仅会增加腹腔镜全腹膜外疝修补术的手术难度,而且增加了手术并发症的发生率,这提示疝外科医师应增加对于弓状线变异的认识,进而提高手术熟练度及安全度。Objective:To explore the anatomical analysis and clinical significance of arcuate line variation in laparoscopic total extraperitoneal hernia repair.Methods:A total of 84 patients with inguinal hernia were selected and divided into high arcuate line group,classic arcuate line group,low arcuate line group,multiple arcuate line group and no arcuate line group according to the position and marking of the patient’s arcuate line.The intraoperative and postoperative rehabilitation of each group were compared.Results:By measuring the distance from the umbilicus to the arcuate line in 84 patients,the groupings were as follows:40 cases in classic arcuate line group,accounting for 47.62%;7 cases in high arcuate line group,accounting for 8.33%;13 cases in low arcuate line group,accounting for 15.48%;21 cases in multiple arcuate line group,accounting for 25%;3 cases in no arcuate line group,accounting for 3.57%.In terms of the difficulty and the clarity of surgery,the scores of low arcuate line group,multiple arcuate line group and no arcuate line group were lower than those of classic arcuate line group(P<0.05),and the classic arcuate line group had similar score compared with high arcuate line group(P>0.05).In terms of operation time,classic arcuate line group had shortest time,and no arcuate line group had longest time(all P<0.05).The incidence of peritoneal injury,inferior abdominal vascular injury,conversion surgery(open/TAPP)and hematoma in classic arcuate line group was lower than that in low arcuate line group,multiple arcuate line group and no arcuate line group(all P<0.05).The incidence of vascular injury was the lowest in high arcuate line group.In terms of emphysema,the incidence rate of classic arcuate line group was higher than that of low arcuate line group,multiple arcuate line group and no arcuate line group(all P<0.05).Conclusion:Variation of arcuate line not only increases the difficulty of laparoscopic total extraperitoneal hernia repair,but also increases the incidence of surgical complications,which s

关 键 词：弓状线变异 疝修补术 腹腔镜 解剖分析 并发症 

分 类 号：R656.4[医药卫生—外科学]