腹腔镜腹股沟斜疝修补术中关闭疝环的临床意义  

Clinical Significance of Closing Hernia Ring in Laparoscopic Indirect Inguinal Hernia Repair

作　　者：李嵩 林晖 Li Song;Lin Hui(Department of General Surgery,Fuzhou First Hospital,Fujian Medical University,Fuzhou 350000,China)

机构地区：[1]福建医科大学附属福州市第一医院普通外科,福州350000

出　　处：《中国微创外科杂志》2023年第11期824-829,共6页Chinese Journal of Minimally Invasive Surgery

基　　金：福建省自然科学基金(2019J01540)。

摘　　要：目的 研究腹腔镜腹股沟斜疝修补术中关闭疝环的临床价值。方法 回顾性分析2021年1月~2022年10月160例GibertⅡ型(内环缺损1.5~3.0 cm)、Ⅲ型(内环缺损>3.0 cm或阴囊疝)腹股沟斜疝的临床资料,均行腹腔镜经腹腹膜前疝修补术(transabdominal preperitoneal hernia repair, TAPP),一位术者五针缝合关闭内环口(观察组),另一位术者不关闭内环口(对照组),各80例。比较2组术后血清肿情况,以及手术时间、术中出血量、术后疼痛评分、术后住院时间以及损伤、感染、慢性疼痛、复发等并发症发生率。结果 (1)观察组术后第7天和术后1个月血清肿发生率低于对照组[8.8%(7/80)vs. 26.3%(21/80),χ^(2)=8.485,P=0.004;3.8%(3/80)vs.13.8%(11/80),χ^(2)=5.010,P=0.025],术后3个月2组血清肿发生率差异无统计学意义(P>0.05)。(2)观察组手术时间[(84.7±21.4)min]长于对照组[(72.3±15.8)min](t=4.188,P=0.000),2组手术出血量、术后第1天疼痛评分及术后住院时间差异均无统计学意义(P>0.05),2组均未发生损伤、中转开放手术、感染、疝复发及慢性疼痛。结论 疝环关闭技术用于Ⅱ、Ⅲ型腹股沟斜疝腹腔镜TAPP手术,可有效减少术后血清肿发生率,且不增加其他并发症。Objective To study the clinical significance of closing the hernia ring in laparoscopic transabdominal preperitoneal hernia repair(TAPP).Methods A retrospective analysis was made on clinical data of 160 patients with Gibert typeⅡ(the internal ring defect was 1.5-3.0 cm)andⅢ(the internal ring defect was>3.0 cm or scrotal hernia)indirect inguinal hernia from January 2021 to October 2022.All the patients received TAPP.One surgeon closed the hernia ring with five stitches(observation group),while another surgeon did not close the henia ring(control group),with 80 cases in each group.The operation time,intraoperative bleeding,postoperative pain score,postoperative hospitalization stay and incidence of complications such as injury,seroma,infection,chronic pain and recurrence,were observed in the two groups.Results①On the 7th day and at 1 month after surgery,the incidence rate of seroma in the observation group was lower than those in the control group[8.8%(7/80)vs.26.3%(21/80),χ2=8.485,P=0.004;3.8%(3/80)vs.13.8%(11/80),χ2=5.010,P=0.025].At 3 months after surgery,there was no significant difference of the incidence rate of seroma between the two groups(P>0.05).②The operation time of the observation group[(84.7±21.4)min]was longer than that of the control group[(72.3±15.8)min,t=4.188,P=0.000].There was no significant difference between the two groups in the amount of bleeding,postoperative pain score on the first day after surgery and postoperative hospitalization stay(P>0.05).There were no complications such as unexpected injuries,conversion to open surgery,infection,hernia recurrence,or chronic pain in both groups.Conclusion Application of hernia ring closure technique in TAPP operation for type Ⅱ and Ⅲ indirect inguinal hernia can effectively reduce the incidence of postoperative seroma,without increasing other complications.

关 键 词：腹股沟斜疝 内环关闭 血清肿 经腹腹膜前疝修补术 

分 类 号：R656.21[医药卫生—外科学]