层面分离法与镜推分离法在腹腔镜全腹膜外腹股沟疝修补术中的倾向性评分匹配对比研究  

A propensity score matched comparison of plane dissection and telescopic dissection for totally extraperitoneal inguinal hernia repair

作　　者：周上军[1] 邓锐斌 占平[1] 黄海 邓艳庆 张培杰 张焕彬 周学鲁 Zhou Shangjun;Deng Ruibin;Zhan Ping;Huang Hai;Deng Yanqing;Zhang Peijie;Zhang Huanbin;Zhou Xuelu(Department of Surgery,Dongguan Hospital of Guangzhou University of Chinese Medicine,Dongguan 523002,China;Department of Surgery,Chashan Hospital Affiliated to Guangdong Medical University,Dongguan 523378,China)

机构地区：[1]广州中医药大学东莞医院外科,东莞523002 [2]广东医科大学茶山医院外科,东莞523378

出　　处：《中华普通外科学文献(电子版)》2025年第2期101-105,共5页Chinese Archives of General Surgery(Electronic Edition)

摘　　要：目的评估层面分离法(PD)与镜推分离法(TD)在腹腔镜全腹膜外腹股沟疝修补术(TEP)中的安全性与有效性,特别关注手术视野的质量。方法回顾性分析2017年1月至2023年10月在广州中医药大学东莞医院和广东医科大学茶山医院接受PD的TEP患者146例(PD组),通过倾向性评分匹配尽量减少混淆因素的影响,在同期手术患者中,按12最优配对匹配TD组292例。主要观察指标包括腹膜损伤、血管损伤、手术视野清晰度、手术时间、术中出血量、术后总并发症和严重并发症发生率,次要观察指标包括住院时间、术后疼痛和复发率等。结果倾向性评分匹配后,两组在关键预后因素上均衡,具有可比性。PD组手术视野清晰度Ⅰ级和Ⅳ级优于TD组(χ^(2)=5.310、4.074;P=0.021、0.044),术中出血量少于TD组(t=2.875,P=0.004),且手术时间较短(t=4.484,P<0.001)。TD组住院费用高于PD组(t=6.869,P<0.001)。两组在住院时间和随访时间上差异无统计学意义。在总并发症发生率上有显著差异(χ^(2)=6.778,P=0.009),主要是腹膜损伤(χ^(2)=6.665,P=0.010)。虽然TD组中1例出血超过500 ml,1例主动脉损伤,但两组在严重并发症方面差异无统计学意义(χ^(2)=0.501,P=0.479)。此外,两组患者均未发生切口感染和慢性疼痛并发症。结论PD与TD在TEP中均展现出有效性与可靠性。PD在手术视野清晰度、减少腹膜损伤方面表现更优,并能缩短手术时间,减少术中出血量和费用支出,在TEP中具备较大的应用潜力。Objective To evaluate the safety and efficacy of plane dissection(PD)versus telescopic dissection(TD)in totally extraperitoneal(TEP)laparoscopic hernioplasty,with special focus on the quality of surgical field vision.Methods A retrospective analysis was conducted on 146 patients who underwent PD from January 2017 to October 2023 in Dongguan Hospital of Guangzhou University of Chinese Medicine and Chashan Hospital Affiliated to Guangdong Medical University.Propensity score matching(PSM)was used to minimize the impact of confounding factors.Among the patients who received operation at the same period,292 cases were matched with TD group in the optimal proportion of 12.The primary outcomes included peritoneal damage,vascular injury,clarity of surgical field vision,operation time,intraoperative blood loss,and complications.Secondary outcomes were length of hospital stay,postoperative pain,recurrence rate,and so on.Results After PSM,the two groups were comparable in terms of key prognostic factors.The PD group had significantly better clarity of surgical field vision compared to the TD group(grade:χ^(2)=5.310,P=0.021;grade:4.074,P=0.044),less intraoperative blood loss,and shorter operation time(t=2.875,4.484;P=0.004,<0.001).The TD group had higher costs than the PD group(t=6.869,P<0.001).There were no statistically significant differences between the two groups in terms of length of hospital stay and follow-up duration.The overall complication rate was significantly different between the two groups(χ^(2)=6.778,P=0.009),mainly due to differences in peritoneal injuries(χ^(2)=6.665,P=0.010).Although one case in the TD group had bleeding exceeding 500 ml and one case of aortic injury,there were no statistical differences in severe complications classified by the Clavien-Dindo system between the two groups(χ^(2)=0.501,P=0.479).Additionally,there were no incisional infections or chronic pain in either group.Conclusions Both PD and TD demonstrate effectiveness and reliability in TEP surgery.PD shows superior performance

关 键 词：疝 腹股沟 腹腔镜 腹腔镜全腹膜外修补术 层面分离 镜推分离 倾向性评分匹配 手术视野 

分 类 号：R65[医药卫生—外科学]