侧方入路单孔腹腔镜完全腹膜外腹股沟疝修补术(附110例报告)  

Lateral approach single⁃incision laparoscopic totally extraperitoneal inguinal hernia repair:a report of 110 cases

作　　者：张一忠 汤睿[2] 王廷峰 司仙科[4] 叶乐斌 柳楠 项世骏 吴卫东[6] ZHANG Yizhong;TANG Rui;WANG Tingfeng;SI Xianke;YE Lebin;LIU Nan;XIANG Shijun;WU Weidong(Department of Hernia and Hepatobiliary Surgery,the First Affiliated Hospital of Ningbo University,Zhejiang Ningbo 315020,China;Department of Hernia and Abdominal Wall Surgery,Shanghai East Hospital,Tongji University,Shanghai 200120,China;Department of Gastrointestinal Surgery,Shanghai Pudong Hospital,Fudan University Pudong Medical Center,Shanghai 201399,China;Department of Hernia and Abdominal Wall Surgery,Putuo Hospital,Shanghai Univer-sity of Traditional Chinese Medicine,Shanghai 200062,China;Department of General Surgery,Beilun District Hospital of Traditional Chinese Medicine,Zhejiang Ningbo 315899,China;Gastrointestinal Surgery Department of General Surgery Center,Shanghai General Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200080,China)

机构地区：[1]宁波大学附属第一医院肝胆疝外科,浙江宁波315020 [2]同济大学附属东方医院疝与腹壁外科,上海200120 [3]复旦大学附属浦东医院胃肠外科,上海201399 [4]上海中医药大学附属普陀医院疝与腹壁外科,上海200062 [5]宁波市北仑区中医院普外科,浙江宁波315899 [6]上海交通大学医学院附属第一人民医院普外中心胃肠外科,上海200080

出　　处：《外科理论与实践》2024年第4期323-328,共6页Journal of Surgery Concepts & Practice

基　　金：浦东新区卫生系统学科带头人培养计划(PWRd2020⁃19)。

摘　　要：目的:报道侧方入路单孔腹腔镜完全腹膜外腹股沟疝(L⁃SILTEP)修补这一应用于特定情况下腹股沟疝的全新术式。方法:回顾性分析2021年6月至2024年3月宁波大学附属第一医院、上海交通大学医学院附属第一人民医院、同济大学附属东方医院完成的110例腹股沟疝L⁃SILTEP的资料,分析病例资料、手术细节、住院时间和术后情况。结果:手术均顺利完成,无中转。中位手术时间55(41.25,70)min。术中平均出血量5(2,10)mL。术中腹壁下血管损伤5例(4.5%),精索损伤1例(0.9%)。术后6、24和48 h疼痛平均视觉模拟评分(VAS)分别为(3.0±0.8)分、(1.9±0.7)分和(1.1±0.4)分。平均住院时间(3.3±0.7)d。术后并发症常见为腹股沟区血清肿(9例,8.2%),腹膜外间隙血肿1例(0.9%),阴囊积液1例(0.9%)。结论:L⁃SILTEP安全、方便、有效。因其技术要求高,应用限于特定的病人和医师。开展该手术需要重视培训和技术细节,谨慎开展。Objective To present the initial practice of a novel procedure for the surgical treatment of inguinal hernia-“lateral approach single⁃incision laparoscopic totally extraperitoneal(L⁃SILTEP)repair”in certain specific situations.Methods The clinical data of 110 inguinal hernia patients who underwent L⁃SILTEP in the First Affiliated Hospital of Ningbo University,Shanghai General Hospital affiliated to Shanghai Jiao Tong University School of Medicine,and Shanghai East Hospital affiliated to Tongji University from June 2021 to March 2024 were collected retrospectively.Patients'demographics,surgical details,length of hospital stay,and postoperative outcomes were analyzed respectively.Results All surgeries were completed successfully and there was no conversion.The median surgical time was 55(41.25,70)mins and the intraoperative blood loss was 5(2,10)mL.In surgery,inferior epigastric artery injury occurred in 5 cases(4.5%)and spermatic cord injury occurred in 1 case(0.9%).The mean visual analog scale(VAS)scores pain assessment at 6,24,and 48 h after surgery were 3.0±0.8,1.9±0.7 and 1.1±0.4,respectively.The duration of hospital stay was(3.3±0.7)days.The most common postoperative complication was seroma,which occurred in 9 cases(8.2%).Additionally,extraperitoneal hematoma occurred in 1 case(0.9%)and scrotum effusion in 1 case(0.9%).Conclusions Generally,L⁃SILTEP is safe,feasible and effective.However,due to its advanced technique⁃demand,the application of L⁃SILTEP should be patient⁃specific and surgeon⁃specific.The successful implementation of this surgical procedure necessitates extensive training and meticulous attention to the surgical details.

关 键 词：腹股沟疝 单孔腹腔镜 完全腹膜外修补 侧方入路 

分 类 号：R656.21[医药卫生—外科学]