经腹直肌后入路与脐下入路腹腔镜全腹膜外腹股沟疝修补术的前瞻性随机对照研究  

A Prospective Randomized Controlled Study of Retromuscular Approach and Subumbilical Approach in Laparoscopic Totally Extraperitoneal Inguinal Hernia Repair

作　　者：黄海 张曼 邓艳庆 张培杰 王友华 骆剑华 周学鲁 HUANG Hai;ZHANG Man;DENG Yanqing;ZHANG Peijie;WANG Youhua;LUO Jianhua;ZHOU Xuelu(Department of Surgery,Chashan Hospital of Guangdong Medical University,Dongguan 523380,China;不详)

机构地区：[1]广东医科大学茶山医院外科,广东东莞523380 [2]广东医科大学茶山医院体检科,广东东莞523380

出　　处：《中国医学创新》2025年第8期86-91,共6页Medical Innovation of China

基　　金：东莞市社会发展科技重点项目(20221800905292)。

摘　　要：目的:对比经腹直肌后入路和脐下入路在腹腔镜全腹膜外腹股沟疝修补术(TEP)的安全性和有效性。方法:选取2019年11月—2023年12月广东医科大学茶山医院外科收治的312例腹股沟疝患者,均接受TEP治疗,随机分为经腹直肌后入路组(rTEP组,n=156)和脐下入路(sTEP组,n=156)。主要观察指标包括手术视野清晰度、手术时间、术中出血量和术后并发症发生率;次要观察指标包括住院时间和复发率。结果:与sTEP组相比,rTEP组手术视野清晰,手术时间、住院时间均短,术中出血量、住院费用、术后并发症发生率均低(P<0.05)。rTEP组腹膜损伤和腹壁下血管损伤发生率均低于sTEP组(P<0.05),在切口感染、血清肿、血肿发生率方面,两组差异均无统计学意义(P>0.05)。随访期间,两组均无切口感染、慢性疼痛和复发病例。结论:尽管两组手术入路分离方法的临床治疗效果相似,但经腹直肌后入路可提高手术视野清晰度,减少出血量,缩短手术时间和住院时间,减少医疗费用,并降低手术并发症发生率。Objective:To evaluate safety and efficacy of the retromuscular approach versus the subumbilical approach in laparoscopic totally extraperitoneal(TEP)inguinal hernia repair.Method:A total of 312 patients with inguinal hernias who underwent TEP surgery at Chashan Hospital of Guangdong Medical University from November 2019 to December 2023 were included,all of whom received TEP treatment.Patients were randomly assigned to either the retromuscular approach group[retromuscular approach totally extraperitoneal(rTEP)group,n=156]or the subumbilical approach group[subumbilical approach totally extraperitoneal(sTEP)group,n=156].The primary outcomes assessed included surgical field clarity,operation time,intraoperative blood loss and postoperative complication rates.Secondary outcomes comprised hospital stay duration and recurrence rates.Result:Compared with sTEP group,rTEP group had clear surgical field of view,the operation time and hospitalization time were short,the intraoperative blood loss,hospitalization cost and postoperative complication rate were low(P<0.05).The incidences of peritoneal injury and inferior epigastric vessels injury in the rTEP group were lower than those in the sTEP group(P<0.05);there were no significant differences in the incidences of incision infection,seroma and hematoma between the two groups(P>0.05).During follow-up,there were no cases of incision infection,chronic pain,or recurrence in either group.Conclusion:Although the clinical therapeutic effect is similar between the two surgical approaches,the retromuscular approach can provide a clearer operative field,reduce the bleeding volume,shorten the operation time and hospital stay,cut down medical cost and decrease complications.

关 键 词：腹腔镜全腹膜外腹股沟疝修补术 经腹直肌后入路 脐下入路 并发症 

分 类 号：R65[医药卫生—外科学]