T型疝囊切开游离巨大斜疝疝囊在腹腔镜下经腹腔腹膜前 疝修补术中的应用
| 作者: |
1周太成,
1于洪燕,
1马宁,
1陈文豪,
1江志鹏,
1李英儒,
1甘文昌,
1侯泽辉,
1陈双
1 中山大学附属第六医院 胃肠、疝和腹壁外科；广东省结直肠盆底疾病研究重点实验室，广东 广州 510655 |
| 通讯: |
陈双
Email: sysusc@126.com |
| DOI: | 10.3978/.2018.04.014 |
| 基金: | 广东省科技计划资助项目（2017A020215036）。 |
摘要
目的：探讨T型切开疝囊在腹腔镜下经腹腔腹膜前疝修补术（TAPP）中游离斜疝巨大疝囊的临床效果。
方法：选择2013年1月—2016年1月中山大学附属第六医院收治并拟行腹腔镜下TAPP的150例符合入选标准的巨大腹股沟斜疝患者，用电脑数字表法随机分为对照组（76例）和研究组（74例），对照组采用常规方法游离疝囊，研究组采用T型切开疝囊，并向两侧游离。比较两组的相关临床指标。
结果：两组患者在在年龄、体质量指数、发病时间、疝缺损大小等方面差异均无统计学意义（均P>0.05）。与对照组比较，研究组的平均疝囊游离时间（8.3 min vs. 11.2 min）、平均术中出血量（2.1 mL vs. 4.3 mL）、平均手术时间（47.2 min vs. 51.3 min）均明显减少（均P<0.05）；两组患者手术后均无复发及补片部位感染，研究组术后血清肿发生率明显低于对照组（2.6% vs. 8.1%，P=0.029）；两组术后疼痛视觉模拟评分、住院时间及住院费用均无统计学差异（均P>0.05）。
结论：在TAPP巨大斜疝疝囊游离中采用T型疝囊切开，能显著缩短游离及手术时间，减少术中出血，且不增加术后并发症的发生。
关键词：
疝，腹股沟；疝修补术；腹腔镜
方法：选择2013年1月—2016年1月中山大学附属第六医院收治并拟行腹腔镜下TAPP的150例符合入选标准的巨大腹股沟斜疝患者，用电脑数字表法随机分为对照组（76例）和研究组（74例），对照组采用常规方法游离疝囊，研究组采用T型切开疝囊，并向两侧游离。比较两组的相关临床指标。
结果：两组患者在在年龄、体质量指数、发病时间、疝缺损大小等方面差异均无统计学意义（均P>0.05）。与对照组比较，研究组的平均疝囊游离时间（8.3 min vs. 11.2 min）、平均术中出血量（2.1 mL vs. 4.3 mL）、平均手术时间（47.2 min vs. 51.3 min）均明显减少（均P<0.05）；两组患者手术后均无复发及补片部位感染，研究组术后血清肿发生率明显低于对照组（2.6% vs. 8.1%，P=0.029）；两组术后疼痛视觉模拟评分、住院时间及住院费用均无统计学差异（均P>0.05）。
结论：在TAPP巨大斜疝疝囊游离中采用T型疝囊切开，能显著缩短游离及手术时间，减少术中出血，且不增加术后并发症的发生。
Application of T-shaped incision of the hernia sac for giant indirect hernia sac separation during transabdominal preperitoneal inguinal hernia repair
CorrespondingAuthor:CHEN Shuang Email: sysusc@126.com
Abstract
Objective: To investigate clinical efficacy of using T-shaped incision of the hernia sac for separation of the giant hernia sac during transabdominal preperitoneal (TAPP) inguinal hernia repair.
Methods: One-hundred and fifty eligible patients with giant oblique inguinal hernia scheduled to undergo TAPP during January 2013 to January 2016 in the Sixth Affiliated Hospital of Sun Yat-sen University were enrolled. Using a computer-generated random number table, the patients were randomly assigned to control group (76 cases) and study group (74 cases). Patients in control group underwent conventional separation of the hernia sac, and those in study group underwent T-shaped hernia sac incision and two directional dissection. The main clinical variables between the two groups were compared.
Results: There were no significant differences in age, body index mass, time of onset, and size of the hernia defect between the two groups (all P>0.05). In study group compared with control group, the average time for hernia sac separation (8.3 min vs. 11.2 min), average intraoperative blood loss (2.1 mL vs. 4.3 mL), and average operative time (47.2 min vs. 51.3 min) were all significantly reduced (all P<0.05). No postoperative recurrence or mesh infection occurred in either group. The incidence of postoperative seroma in study group was significantly lower than that in control group (2.6% vs. 8.1%, P=0.029). The scores of visual analogue scale, length of hospital stay and hospitalization costs showed no significant difference between the two groups (all P>0.05).
Conclusion: Using T-shaped incision of the hernia sac during TAPP separation of the giant hernia sac can effectively shorten the separation and operative time, and reduce the intraoperative blood loss, with no increase of incidence of postoperative complications.
Keywords：
Hernia
Inguinal; Herniorrhaphy; Laparoscopes
Methods: One-hundred and fifty eligible patients with giant oblique inguinal hernia scheduled to undergo TAPP during January 2013 to January 2016 in the Sixth Affiliated Hospital of Sun Yat-sen University were enrolled. Using a computer-generated random number table, the patients were randomly assigned to control group (76 cases) and study group (74 cases). Patients in control group underwent conventional separation of the hernia sac, and those in study group underwent T-shaped hernia sac incision and two directional dissection. The main clinical variables between the two groups were compared.
Results: There were no significant differences in age, body index mass, time of onset, and size of the hernia defect between the two groups (all P>0.05). In study group compared with control group, the average time for hernia sac separation (8.3 min vs. 11.2 min), average intraoperative blood loss (2.1 mL vs. 4.3 mL), and average operative time (47.2 min vs. 51.3 min) were all significantly reduced (all P<0.05). No postoperative recurrence or mesh infection occurred in either group. The incidence of postoperative seroma in study group was significantly lower than that in control group (2.6% vs. 8.1%, P=0.029). The scores of visual analogue scale, length of hospital stay and hospitalization costs showed no significant difference between the two groups (all P>0.05).
Conclusion: Using T-shaped incision of the hernia sac during TAPP separation of the giant hernia sac can effectively shorten the separation and operative time, and reduce the intraoperative blood loss, with no increase of incidence of postoperative complications.