基于膜解剖与腹膜前间隙解剖在腹腔镜全腹膜外疝修补术中的临床疗效比较

doi:10.3969/j.issn.1005-6483.2020.12.020

摘要/Abstract

摘要： 目的比较不同解剖部位在腹腔镜全腹膜外疝修补术中的临床疗效。
方法 2019年2月～2020年4月中大医院及溧水分院行全腹膜外疝修补手术(totally extraperitoneal，TEP)的腹股沟疝病人82例，根据不同解剖下的TEP手术方式将82例病人分为A组和B组，每组各41例，A组给予膜解剖下腹腔镜全腹膜外疝修补术，B组行基于腹膜前间隙解剖下腹腔镜全腹膜外疝修补术，比较两组病人手术时间、术中出血量、恢复限制性活动时间、住院时间、中转手术率、术后复发率及尿潴留、肠梗阻、血清肿、阴囊水肿等相关并发症发生率。
结果 A组手术时间、术中出血量、恢复限制性活动时间、住院时间均少于B组，差异有统计学意义(P＜0.05);两组病人术后12小时内VAS评分差异，无统计学意义，A组术后24h、48h、7d、15d VAS评分明显低于B组，差异有统计学意义(P＜0.05)。30天后两组病人疼痛均基本消失；A组中转开放手术率、术后并发症均明显低于B组,差异有统计学意义(P＜0.05)。
结论熟练掌握腹股沟区膜解剖有助于提高TEP的操作安全性，缩短手术时间，减少术后复发率及手术并发症的发生。

关键词: 膜解剖, 腹膜前间隙解剖, 腹腔镜, 疝修补术, 临床疗效

Abstract: Objective To compare the clinical efficacy of laparoscopic total extraperitoneal hernia repair based on different anatomical sites.
Methods The Clinical data of 82 patients with inguinal hernia who underwent totally extraperitoneal hernia repair(TEP) in our hospital from February 2019 to April 2020 were collected for retrospective analysis.According to the TEP operation under different anatomy,all the patients were divided into two groups with 41 patients in each group.Group A was given membrane dissection under laparoscopic total extraperitoneal hernia repair,group B line based on the anatomy of the peritoneal clearance before laparoscopic total extraperitoneal hernia repair.The operative time,intraoperative blood loss,recovery time of restricted activities,length of stay,rate of conversion to open surgery,rate of postoperative recurrence,and incidence of complications related to urinary retention,intestinal obstruction,seroma,and scrotal edema were analyzed and compared between the two groups.
Results The time of operation,the amount of bleeding during operation,the time of recovery of restrictive activity and the time of hospitalization in group A were significantly shorter than those in group B,the difference was statistically significant(P＜0.05).There was no significant difference in VAS score within 12 hours after operation between the two groups,and the VAS score in group A was significantly lower than that in group B at 24 hours,48 hours,7 days and 15 days after operation,the difference was statistically significant(P<0.05).After 30 days,the pain of the two groups basically disappeared;the rate of conversion to open surgery and postoperative complications in group A were significantly lower than those in group B,the difference was statistically significant(P＜0.05).
Conclusion Mastering the anatomy of inguinal region membrane is helpful to improve the safety of laparoscopic total extraperitoneal hernia repair,shorten the operation time,reduce the recurrence rate and postoperative complications.

Key words: membrane anatomy, anatomy of the preperitoneal space, laparoscope, hernia repair, clinical curative effect

熊波李俊生严征远洪智. 基于膜解剖与腹膜前间隙解剖在腹腔镜全腹膜外疝修补术中的临床疗效比较[J]. 临床外科杂志, 2020, 28(12): 1154-1156.

XIONG Bo, LI Junsheng, YAN Zhengyuan, et al.. To compare the clinical efficacy of membrane anatomy and preperitoneal space anatomy in laparoscopic total peritoneal external hernia repair[J]. JOURNAL OF CLINICAL SURGERY, 2020, 28(12): 1154-1156.

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