腹腔镜全腹膜外腹股沟疝修补术操作孔布局方式的选择及可视逆向穿刺技术的应用体会  

The selection of operation incision layout method and application experience of visual reverse puncture technique in laparoscopic totally extraperitoneal inguinal hernia repair

作　　者：杨剑辉 左志豪 何丽佳 YANG Jian-hui;ZUO Zhi-hao;HE Li-jia(Department of General Surgery,Youxian District Hospital of Traditional Chinese Medicine,Mianyang 621000,China;Department of Clinical Medicine,Southwest Medical University)

机构地区：[1]绵阳市游仙区中医医院普通外科,四川绵阳621000 [2]西南医科大学临床医学系

出　　处：《腹腔镜外科杂志》2022年第9期649-654,共6页Journal of Laparoscopic Surgery

摘　　要：目的:探讨腹腔镜全腹膜外疝修补术(TEP)中根据腹股沟疝类型确定手术方案,选择合理的操作孔布局并采用可视逆向穿刺建孔技术的可行性。方法:回顾分析2019年12月至2021年12月为91例腹股沟疝患者行TEP的临床资料,其中45例患者根据腹股沟疝类型(通过术中腹腔镜探查明确)选择手术方案,确定操作孔布局方式,采取可视逆向穿刺建孔技术(研究组),46例采用常规中线位操作孔布局、正向穿刺建孔(对照组),对比分析两组手术指标及并发症发生率。结果:86例顺利完成TEP,研究组中1例改行腹腔镜经腹腹膜前疝修补术,对照组中4例中转开放。研究组手术时间短于对照组,术中腹膜损伤、术中血管损伤少于对照组,差异有统计学意义(P<0.05)。结论:TEP术中根据腹股沟疝类型选择手术方案,合理选择操作孔布局方式,采用可视逆向穿刺建孔技术可有效降低手术操作难度,缩短手术时间,减少术中腹膜与血管损伤,利于患者术后康复。Objective:To explore how to decide the operation plan according to the inguinal hernia type in laparoscopic totally extraperitoneal(TEP)hernia repair,and the feasibility of reasonable operation incision layout,technology of visual reverse puncture and operation incision construction.Methods:Clinical data of 91 patients who suffered from inguinal hernia and underwent TEP from Dec.2019 to Dec.2021 were retrospectively analyzed.45 patients were divided into the study group,the operation plan and the operation i ncision layout was determined according to the type of inguinal hernia(including intraoperative laparoscopic exploration),and the technology of visual reverse puncture and operation incision construction was adopted.46 patients with conventional midline operation i ncision layout and forward operation incision construction were divided into the control group.Surgical index and complication rates were compared between the two groups.Results:Among the 91 patients,86 successfully underwent TEP;1 in the study group underwent l aparoscopic transabdominal preperitoneal hernia repair,and 4 in the control group were converted to open surgery.Compared with the control group,the operative time,intraoperative peritoneal injury and intraoperative vascular injury in the study group were significantly reduced with statistically significant difference(P<0.05).Conclusions:In TEP repair,choice of surgical plan according to the type of inguinal hernia,reasonable selection of the layout of operation incision and the use of visual reverse puncture incision construction technology can effectively reduce the difficulty of operation,shorten the operation time,reduce the intraoperative peritoneal and vascular i njury,and is conducive to postoperative rehabilitation of patients.

关 键 词：疝 腹股沟 完全腹膜外疝修补术 腹腔镜检查 操作孔布局 可视逆向穿刺技术 

分 类 号：R656.21[医药卫生—外科学]