远端疝囊残端固定与游离对腹股沟斜疝TAPP术后血清肿的影响研究  

Effect of distal hernia sac stump fixation and peritoneal dissociation on removal of hematoma after TAPP surgery for inguinal hernia

作　　者：刘星 吴立胜 王炜林 李猛 Liu Xing;Wu Lisheng;Wang Weilin;Li Meng(Department of the First General Surgery,the First Affiliated Hospital of Fuyang Normal University,Fuyang Anhui Province 236000,China;Department of Hernia and Abdominal Wall Surgery,the First Affiliated Hospital of University of Science and Technology of China,Hefei Anhui Province 230000,China)

机构地区：[1]阜阳师范大学附属第一医院普外一科,安徽阜阳236000 [2]中国科学技术大学附属第一医院疝和腹壁外科,合肥230000

出　　处：《中华普外科手术学杂志（电子版）》2023年第5期550-553,共4页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：阜阳市科学技术局立项项目(FK202081097)。

摘　　要：目的:分析腹股沟斜疝行腹腔镜经腹腹膜前疝修补术(TAPP)中远端疝囊残端固定与游离对术后血清肿的影响。方法:前瞻性选取2020年1月至2022年1月就诊的原发性腹股沟斜疝男性患者(内环≥3 cm或阴囊疝)204例,均行TAPP治疗。采用随机数字表法将患者分为研究组和对照组,每组各102例,研究组疝囊横断后远端疝囊缝合固定于联合腱,对照组将疝囊离断后远端旷置游离于阴囊。采用SPSS 26.0分析数据,血清肿和并发症等计数资料用[例(%)]表示,组间比较行χ^(2)检验,等级计数资料比较行秩和检验;围手术期指标等计量资料用(^(-)x±s)表示,行独立样本t检验。P<0.05为差异有统计学意义。结果:两组患者手术时间、术中出血量、术后住院时间、手术费用及疝复发率比较差异无统计学意义(P>0.05);研究组和对照组患者术后腹股沟区血清肿发生率(8.8%vs.18.6%)和抽液量[(20.6±2.4)vs.(42.7±5.3)]比较,差异有统计学意义(χ^(2)/t=2.107、38.363,P=0.035、0.000);两组患者并发症总发生率(5.9%vs.14.7%)比较,差异有统计学意义(χ^(2)=4.300,P=0.038)。结论:腹股沟斜疝TAPP术中疝囊横断后将远端疝囊缝合并固定于联合腱,可减少TAPP术后血清肿发生率及严重程度,术后并发症更少,手术安全性高,值得在临床推广。Objective To analyze the effect of fixation and dissociation of distal hernia sac stump on postoperative seroma during TAPP operation for oblique inguinal hernia.Methods A total of 204 male patients with primary obtrinal inguinal hernia(inner ring≥3 cm or scrotal hernia)were prospectively selected from January 2020 to January 2022,all of whom received TAPP treatment.Random number table method was used to divide 102 cases into two groups.The study group had the distal hernia sac sutured and fixed in the joint tendon after transection,while the control group had the distal hernia sac isolated and free in the scrotum after dissection.SPSS 26.0 statistical software was used for analysis.Such as seroma and complications were expressed as[n(%)].χ^(2)test was performed for inter-group comparison,and Rank Sum test was performed for rank count data.Measurement data such as perioperative indicators were represented with(^(-)x±s),and t test was used for comparison between groups.P<0.05 was considered statistically significant.Results There was no significant difference in operation time,intraoperative blood loss,postoperative hospital stay,operation cost and hernia recurrence rate between the two groups(P>0.05).There were significant differences in the incidence of postoperative inguinal seroma between the study group and the control group(8.8%vs.18.6%)and the amount of fluid extracted(20.62.4 vs.42.75.3)(χ^(2)/t=2.107,38.363,P=0.035,0.000).The 4.300,P=0.038).Conclusion The distal hernia sac is sutured and fixed to the joint tendon after transection of the hernia sac in TAPP,which can reduce the incidence and severity of postoperative seroma,reduce postoperative complications,and have high surgical safety,which is worthy of clinical promotion.

关 键 词：疝 腹股沟 腹腔镜 疝修补术 疝囊残端 联合腱 血清肿 

分 类 号：R656.21[医药卫生—外科学]