腹腔镜下完全腹膜外Sublay治疗腰疝的疗效分析  

Efficacy of totally extraperitoneal Sublay in the treatment of lumbar hernia

作　　者：杜晨阳 罗文[1] 王勇[1] 段鑫[1] 柯文杰[1] 石念[1] 武英翔 DU Chenyang;LUO Wen;WANG Yong;DUAN Xin;KE Wenjie;SHI Nian;WU Yingxiang(Department of Hernia and Abnominal Wall Surgery,the Central Hospital of Wuhan,Tongji Medical College of Huazhong University of Science and Technology,Wuhan 430014,China)

机构地区：[1]华中科技大学同济医学院附属武汉市中心医院疝与腹壁外科,430014

出　　处：《天津医药》2024年第5期514-517,共4页Tianjin Medical Journal

基　　金：湖北省卫生健康委联合基金立项项目青年重点项目(WJ2019H382)。

摘　　要：目的探讨腹腔镜下完全腹膜外Sublay(TES)补片修补治疗腰疝的优势,分析腰疝修补术后的并发症。方法68例腰疝患者根据手术方式分为开放Sublay组30例和TES组38例,患者均使用轻质大网孔补片。观察2组手术时间、术中出血量、术后首次排气时间、术后6 h进食流质饮食情况、术后第1天和第3天疼痛视觉模拟量表(VAS)评分、术后住院时间、术后2周恢复非限制性活动情况、并发症情况及术后腰疝复发情况。依术后并发症的情况为分并发症组22例和无并发症组46例。分析腰疝术后并发症特征。结果与开放Sublay组比较,TES组手术时间差异无统计学意义,术中出血量减少、术后首次排气时间更早、术后第1天和第3天疼痛VAS评分更低、术后6 h恢复进食比例更高、术后住院时间缩短、2周恢复非限制性活动比例增加、并发症发生率降低(P<0.05)。所有手术患者术后随访周期内均未复发。与无并发症组比较,并发症组年龄≥60岁、继发腰疝、疝囊直径≥5 cm、术前嵌顿、开放Sublay、手术时间≥100 min、术中出血量≥10 mL的比例较高(P<0.05)。结论腹腔镜下TES修补术治疗腰疝比开放Sublay修补手术具有恢复快、术后并发症少的优点,更加安全、有效。Objective To explore the advantages of laparoscopic total extraperitoneal Sublay(TES)mesh repair for lumbar hernia,and to analyze the complications after lumbar hernia repair surgery.Methods Sixty-eight patients with lumbar hernia were divided into the open Sublay group(n=30)and the TES group(n=38).All patients were treated with lightweight,large mesh patches.The time of operation,the amount of bleeding during operation,the time of first exhaust after operation,the diet at 6 hours after operation,the pain visual analogue scale(VAS)at 1 and 3 days after operation,the time of hospitalization after operation,the recovery of unrestricted activity at 2 weeks after operation,the complications and the recurrence of lumbar hernia were observed in the two groups.According to the postoperative complications,patients were divided into two groups:the complication group(n=22)and the non-complication group(n=46).The characteristics of postoperative complications of lumbar hernia were analyzed.Results There was no significant difference in the time of operation between the open Sublay group and the TES group.Compared with the open Sublay group,there were decreased intraoperative blood loss,the earlier first exhaust time,the lower pain VAS score on the 1st and 3rd day after operation,the more proportion of patients resumed fluid diet at 6 h after operation,the shorter hospital stay,increased non-restrictive activity in two weeks and reduced complication rate in the TES group(P<0.05).No recurrence occurred in all patients during the follow-up period.Compared with the non complication group,the complication group had a higher proportion of patients with age≥60 years,secondary lumbar hernia,hernia sac diameter≥5 cm,preoperative incarceration,open sublay,surgical time≥100 minutes and intraoperative bleeding≥10 mL(P<0.05).Conclusion Laparoscopic TES repair for lumbar hernia has the advantages of faster recovery and fewer postoperative complications compared to open Sublay repair,which is safer and more effective.

关 键 词：疝 疝修补术 腹腔镜 手术后并发症 

分 类 号：R656.24[医药卫生—外科学]