摘要
目的探讨缝合法和圈套器法在腹腔镜经腹腹膜前(TAPP)腹股沟直疝修补术关闭直疝缺损中的临床价值,分析其可行性及有效性。方法回顾性分析2019年3月至2022年2月间,复旦大学附属闵行医院普外科共611例(827侧)腹股沟疝行TAPP术,其中单侧或双侧直疝127例(151侧)行直疝缺损关闭。按直疝缺损关闭方法不同分为缝合组和圈套器组,其中圈套器组117侧,缝合组34侧(直接缝合关闭的27侧,圈套后未达到预期效果后改缝合的7侧)。分析2组疝分型、补片选择、操作时间、术后第1天疼痛评分及术后并发症的发生率。结果疝分型,缝合组Ⅲ型、Ⅳ型比例较圈套器组高,差异有统计学意义(P=0.007)。补片选择,2组差异无统计学意义(P=0.321)。操作时间,缝合组(6.40±1.72)min,圈套器组(2.75±1.22)min,差异有统计学意义(P<0.001)。术后第1天疼痛视觉模拟评分,缝合组(2.43±1.06)分,圈套器组(2.20±0.56)分,差异无统计学意义(P=0.094)。圈套器组血清肿1例,血肿1例;缝合组未发生血清肿及血肿。2组均无复发病例。2组无血管、神经、精索组织损伤;无补片、切口感染;无肠管、膀胱破损;无肠梗阻等并发症。结论腹腔镜经腹腹膜前直疝修补术直疝缺损关闭时,缝合法和圈套器法均是合理、安全、有效的选择。两者选择应注重个体化。圈套器法操作简单,缝合法可处理各种直疝缺损。建议采用缝合法处理Ⅲ型、复发疝等复杂缺损。
Objective To analyze the clinical value,feasibility and efficacy of suture and endoloop techniques for the closure of direct hernia defects in laparoscopic trans-abdominal preperitoneal(TAPP)inguinal hernia repair.Methods From March 2019 to February 2022,a total of 611 inguinal hernia patients(827 hernias)who underwent TAPP repair in the Department of General Surgery of Minhang Hospital Affiliated to Fudan University was retrospectively analyzed.Direct hernia defect closure was performed in 127 patients(151 hernias)with unilateral or bilateral direct hernias.Patients were divided into suture group and endoloop group according to different closure techniques.The endoloop group included 117 hernias,and the suture group included 34 hernias,including 27 hernias by direct suture and 7 hernias by suture after endoloop failure.The hernia classification,mesh selection,time of operation,postoperative pain score on the first day and incidence of postoperative complications of both groups were analyzed.Results In terms of hernia classification,the proportions of type Ⅲ and type Ⅳ hernias in the suture group were higher than those in the endoloop group,and the difference was statistically significant(P=0.007).There was no significant difference in mesh selection between the two groups(P=0.321).The time of operation was(6.40±1.72)min in the suture group and(2.75±1.22)min in the endoloop group,with statistically significantly difference(P<0.001).The postoperative pain visual analogue scale(VAS)score was(2.43±1.06)in the suture group and(2.20±0.56)in the endoloop group on the first day after surgery,the difference was statistically significant(P=0.094).There was 1 case of seroma and 1 case of hematoma in the endoloop group.No seroma or hematoma occurred in the suture group.There was no recurrence,no injury of blood vessels or nerves or spermatic cords,no mesh or incision infection,no injury of bowel or bladder,no complications such as intestinal obstruction in bothgroups.Conclusions Suture and endoloop techniques are reasonable,safe and effective to close the direct hernia defect in TAPP repair.The selection of techniques should be individualized.The endoloop technique is simple to operate,and the suture method could solve all kinds of direct hernia defects.It is recommended to use suture method to deal with complex defects such as type III hernias and recurrent hernias.
作者
李金东
乐飞
陆景锋
丁军彬
康捷
张晴
李健文
Li Jindong;Yue Fei;Lu Jinfeng;Ding Junbin;Kang Jie;Zhang Qing;Li Jianwen(Department of General Surgery,Minhang Hospital,Fudan University,Shanghai 200199,China;Department of General Surgery,Ruijin Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200025,China)
出处
《中华疝和腹壁外科杂志（电子版）》
2023年第5期551-556,共6页
Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition)
基金
上海市2020年度“科技创新行动计划”生物医药领域科技支撑专项(20S31907600)
关键词
疝
腹股沟
直疝
圈套器
缝合
腹横筋膜
Hernia inguinal
Direct hernia
Endoloop technique
Suture
Transversalis fascia
作者简介
通信作者:李健文,Email:ljw5@yeah.net
