三人四孔法在腹腔镜腹股沟疝感染补片取出术中的应用观察  

Application of three-operators four-holes method in laparoscopic inguinal hernia infected mesh removal

作　　者：田利飞 仝聪[1] 阎立昆[1] 王小强[1] TIAN Lifei;TONG Cong;YAN Likun;WANG Xiaoqiang(First Department of General Surgery,Shaanxi Provincial People's Hospital,Xi’an 710068,China)

机构地区：[1]陕西省人民医院普外一科,西安710068

出　　处：《山东医药》2022年第33期23-26,共4页Shandong Medical Journal

摘　　要：目的观察三人四孔法在腹腔镜腹股沟疝感染补片取出术中的应用效果。方法因腹腔镜腹股沟疝修补术发生补片感染而接受腹腔镜腹股沟疝感染补片取出术治疗的患者23例,根据腹壁打孔方法及手术组人数不同分为三人四孔法组(12例)及常规组(11例)。三人四孔法组采用三人四孔法(术者、第一助手、扶镜手,主操作孔、辅助操作孔、助手操作孔、观察孔)取出感染补片,常规组采用常规手术方法(术者、扶镜手,主操作孔、辅助操作孔、观察孔)取出感染补片。观察两组患者围手术期指标,包括手术时间、术中出血量、术中副损伤、术后首次排气时间、术后1 d的疼痛视觉模拟(VAS)评分等。出院后随访2~63个月,观察术后并发症发生情况,包括疝复发、感染复发、肠瘘、膀胱瘘等。结果患者均顺利取出感染补片完成手术及随访。三人四孔法组手术时间、术中出血量均低于常规组(P均<0.05)。两组术中副损伤例数、术后首次排气时间、术后1 d的VAS评分无差异(P均>0.05)。两组患者在随访期内均无疝复发、感染复发、肠瘘、膀胱瘘等并发症发生。结论与常规手术方式相比,在腹腔镜腹股沟疝感染补片取出术中应用三人四孔法,可缩短手术时间、减少术中出血量,且不增加术后并发症。Objective To observe the application effect of three-operators four-holes method in laparoscopic inguinal hernia infected mesh removal.Methods Twenty-three patients were treated with laparoscopic mesh removal due to mesh infection after laparoscopic inguinal hernia repair.According to the method of abdominal wall drilling and the number of the operators,they were divided into two groups,which were three-operators four-holes group(12 cases)and conventional group(11 cases).In the three-operators four-holes group,the infected mesh was removed by the three-operators using four-holes(including surgeons,first assistant,mirror holder,and main operating hole,auxiliary operating hole,assistant operating hole,and observation hole),while in the conventional group,the infected mesh was removed by the conventional surgical method(including two-operators and three-holes:surgeons,mirror holder,main operating hole,auxiliary operating hole,and observation hole).The perioperative indicators of the two groups were observed,including operative time,intraoperative blood loss,intraoperative collateral injury,the first postoperative exhaust time,and visual analogue scale(VAS)at 1 day after operation.The patients were followed up for 2-63 months after discharge to observe the postoperative complications,including hernia recurrence,infection recurrence,intestinal fistula,and vesical fistula,etc.Results The infected meshes were successfully removed,and patients completed the follow-up.The operative time and intraoperative blood loss in the three-operators four-holes group were lower than those in the conventional group(all P<0.05).There were no significant differences in the number of intraoperative collateral injury,the first postoperative exhaust time,and the VAS score at 1 day after operation between the two groups(all P>0.05).There were no complications such as hernia recurrence,infection recurrence,intestinal fistula,and vesical fistula in the two groups during the followup period.Conclusion Compared with the conventional operation m

关 键 词：腹腔镜手术 腹腔镜手术操作方法 腹腔镜手术路径 腹股沟疝感染补片取出术 疝修补术并发症 

分 类 号：R615[医药卫生—外科学]