腹腔镜完全腹膜外斜疝修补手术关闭内环口对血清肿发生率的影响  

The impact of internal ring closure on seroma incidence in laparoscopic totally extraperitoneal inguinal hernia repair

作　　者：张庆峰 邓旭明[2] 段巧斌 姚干 张策[1] Zhang Qingfeng;Deng Xuming;Duan Qiaobin;Yao Gan;Zhang Ce(Department of General Surgery,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China;Department of Hernia and Abdominal Wall Surgery,Foshan First People's Hospital,Foshan 528000,Guangdong Province,China)

机构地区：[1]南方医科大学南方医院普外科,广州510515 [2]佛山市第一人民医院疝和腹壁外科,广东528000

出　　处：《中华疝和腹壁外科杂志（电子版）》2024年第3期282-290,共9页Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition)

基　　金：国家自然科学基金(81270565)。

摘　　要：目的确认腹腔镜完全腹膜外斜疝修补手术(TEP)中进行横断疝囊后关闭内环口在降低术后血清肿发生率上是否优于横断疝囊后远端旷置以及完整剥离斜疝疝囊。方法于2021年8月15至2023年9月15日在佛山市第一人民医院疝和腹壁外科募集受试者,按1∶1∶2随机分派至关闭组、旷置组和剥离组,分别施行对应术式,收集住院和随访记录、手术视频、检查报告单等资料,分析比较3组之间术后血清肿发生率、手术时间、术中出血量、术中出血事件、术后疼痛评分及其他术后并发症等的差异。结果454例入组成功,排除术中组间转换及失访病例后共389例纳入统计分析,其中关闭组84例、旷置组82例、剥离组223例,术后血清肿发生率总体为22.62%(88/389),关闭组26.2%(22/84)、旷置组29.3%(24/82)、剥离组18.8%(42/223),3组间差异无统计学意义(P=0.105);将影响血清肿发生率的相关因素(疝囊最大径线、术中出血事件和术中出血量)拟合疝囊处理方式进行分层卡方分析显示,当疝囊最大径线≥10 cm时,剥离组的血清肿发生率高于关闭组(83.3%比31.1%),差异有统计学意义(P=0.001),当手术出血量>5 ml时,旷置组血清肿发生率高于关闭组(90.0%比33.3%),差异有统计学意义(P=0.036)。结论本研究中三种疝囊处理方式有各自的临床适用性,其术后血清肿发生率在总体受试者中无明显差异,完整剥离适用于疝囊最大径线<10 cm的病例且效果更优,而在疝囊最大径线≥10 cm、术中出血量>5 ml时选用关闭内环口方式处理疝囊,在降低血清肿发生率上优于其他两种方式。Objective To determine whether internal ring closure following transverse sac transection during laparoscopic totally extraperitoneal(TEP)inguinal hernia repair is superior in reducing postoperative seroma incidence compared to transverse sac transection with distal sac abandonment or complete sac dissection.Methods From August 15,2021,to September 15,2023,participants were recruited from the Hernia and Abdominal Wall Surgery Department at Foshan First People's Hospital.Participants were randomly assigned in a 1:1:2 ratio to the closure group,abandonment group,or dissection group,respectively.Relevant data,including hospitalization records,follow-up records,surgical videos,and examination reports,were collected to analyze and compare the incidence of postoperative seroma,operation time,intraoperative blood loss,intraoperative bleeding events,postoperative pain scores,and other postoperative complications among the three groups.Results A total of 454 participants were successfully enrolled.After excluding cases that involved intraoperative group crossover or loss to follow-up,389 participants were included in the statistical analysis:84 in the closure group,82 in the abandonment group,and 223 in the dissection group.The overall incidence of postoperative seroma was 22.62%(88/389),with 26.2%(22/84)in the closure group,29.3%(24/82)in the abandonment group,and 18.8%(42/223)in the dissection group.No statistically significant difference was found among the three groups(P=0.105).A stratified chi-square analysis of factors affecting seroma incidence(maximum sac diameter,intraoperative bleeding events,and intraoperative blood loss)showed that when the maximum sac diameter was≥10 cm,the incidence of seroma in the dissection group was significantly higher than in the closure group(83.3%vs 31.1%,P=0.001).When intraoperative blood loss was>5 ml,the incidence of seroma in the abandonment group was significantly higher than in the closure group(90.0%vs 33.3%,P=0.036).Conclusion Each of the three sac management techniques has

关 键 词：腹腔镜 完全腹膜外疝修补术 腹股沟斜疝 内环口关闭 血清肿 

分 类 号：R656.21[医药卫生—外科学]