透壁缝合法处理直疝假性疝囊预防术后血清肿应用研究

doi:10.3877/cma.j.issn.1674-392X.2020.01.005

中华疝和腹壁外科杂志(电子版) ›› 2020, Vol. 14 ›› Issue (01) : 18 -22. doi: 10.3877/cma.j.issn.1674-392X.2020.01.005

所属专题：文献；

临床论著

透壁缝合法处理直疝假性疝囊预防术后血清肿应用研究

谢志华¹, 莫宇轩²^,^†(

), 李炳根³, 龚独辉³, 崔文博³, 彭永辉³, 聂向阳³

^1. 511483　广州市番禺区沙湾人民医院普通外科
^2. 315010　宁波，中国科学院大学宁波华美医院胃肠疝外科
^3. 511400　广州市番禺区何贤纪念医院肝胆疝外科

收稿日期:2019-08-01 出版日期:2020-02-18
通信作者: 莫宇轩
基金资助:
广州市番禺区科技计划项目(2018-Z04-62)

Transadominal suture technique in closing pseudohernia sac of direct hernia for seroma prevention after laparoscopic direct inguinal hernia repair

Zhihua Xie¹, Yuxuan Mo²^,^†(), Duhui Gong³, Binggen Li³, Daqiang Li³, Wenbo Cui³, Yonghui Peng³

^1. Department of General Surgery, Shawan People's Hospital in Panyu District, Guangzhou 511483, China
^2. Department of Gastrointestinal and Hernia Surgery, Hwa Mei Hospital, University of Chinese Academy of Science, Ningbo 315010, China
^3. Department of Hepatobiliary and Hernia Surgery, HeXian Memorial Hospital in Panyu District, Guangzhou 511400, China

Received:2019-08-01 Published:2020-02-18
Corresponding author: Yuxuan Mo

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引用本文：

谢志华, 莫宇轩, 李炳根, 龚独辉, 崔文博, 彭永辉, 聂向阳. 透壁缝合法处理直疝假性疝囊预防术后血清肿应用研究[J/OL]. 中华疝和腹壁外科杂志(电子版), 2020, 14(01): 18-22.

Zhihua Xie, Yuxuan Mo, Duhui Gong, Binggen Li, Daqiang Li, Wenbo Cui, Yonghui Peng. Transadominal suture technique in closing pseudohernia sac of direct hernia for seroma prevention after laparoscopic direct inguinal hernia repair[J/OL]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2020, 14(01): 18-22.

目的

探讨在腹腔镜腹股沟疝修补术中使用透壁缝合法处理腹股沟直疝假性疝囊预防术后血清肿的效果。

方法

广州市番禺区何贤纪念医院肝胆疝外科自2017年1月1日至2018年6月30日手术治疗的74例直疝患者，其中Ⅰ型疝12例、Ⅱ型37例、Ⅲ型25例，62例Ⅱ型及Ⅲ型患者术中行透壁缝合法处理直疝假性疝囊。

结果

74例患者均在腹腔镜下顺利完成腹股沟直疝无张力修补术。Ⅰ型疝手术时间为（38.42±2.81）min，出血量为（4.42±2.31）ml，术后1 d视觉模拟评分（VAS）（2.83±1.19）分，7 d VAS（1.00±0.85）分；Ⅱ型手术时间为（44.49±3.25）min，出血量为（7.00±1.75）ml，术后1 d VAS（2.84±1.21）分，7 d VAS（1.08±0.83）分；Ⅲ型手术时间为（50.64±3.35）min，出血量为（5.92±2.60）ml，1 d VAS（2.84±1.18）分，7 d VAS（0.92±0.86）分。术后随访期无血清肿发生、无睾丸肿胀疼痛、无性生活障碍、无疝复发及腹股沟区慢性疼痛出现。

结论

腹腔镜腹股沟疝修补术中透壁缝合法处理直疝假性疝囊对于预防术后血清肿是一种安全、有效、可靠的技术，不增加术后疝复发率及慢性疼痛，值得临床进一步研究。

关键词: 腹股沟疝, 腹腔镜, 直疝, 血清肿

Objective

To investigate the efficacy of transadominal suture technique with a needle forcep in close of the pseudohernia sac of direct hernia for the prevention of seroma formation under laparoscopic direct inguinal hernia repair.

Methods

74 patients with direct hernia (12 cases of type Ⅰ, 37 cases of type Ⅱ, 25 cases of type Ⅲ) were treated surgically fom January 1, 2017 to June 30, 2018. The pseudohernia sac was managed by transadominal suture technique in 62 cases of type II and type III during operation.

Results

All patients underwent surgery successfully. For type I hernia, the operation time was (38.42±2.81) minutes, the bleeding volume was (4.42±2.31) ml, the postoperative pain score was (2.83±1.19) at 1^st day, and (1.00±0.85) at 7^th day; For type Ⅱ, (44.49±3.25) minutes, (7.00±1.75) ml, (2.84±1.21) at 1^st day, and (1.08±0.83) at 7^th day; For type Ⅲ, (50.64±3.35) minutes, (5.92±2.60) ml, (2.84±1.18) at 1^st day, and (0.92±0.86) at 7^th day. There was no seroma formation, testicular swelling and pain, sexual disturbanceand, hernia recurrence and chornic groin pain after operation and during follow-up.

Conclusion

The management of pseudohernia sac of direct hernia with transadominal suture technique during laparoscopic direct inguinal hernia repair is safe, efficient and reliable for prevention of post-operative seroma formation, without increasing hernia recurrence and the risk of developing chronic groin pain, which is worth of being generalized.

Key words: Inguinal hernia, Laparoscopes, Direct hernia, Seroma

图1 直疝三角缺损及直疝假性疝囊示意图

图2 透皮缝合法手术步骤

表1 各型疝手术时间、术中出血量及术后疼痛评分资料

疝分型	例数	手术时间(min)	出血量(ml)	术后疼痛评分(分)
疝分型	例数	手术时间(min)	出血量(ml)	第1天	第7天
Ⅰ型	12	38.42±2.81	4.42±2.31	2.83±1.19	1.00±0.85
Ⅱ型	37	44.49±3.25	7.00±1.75	2.84±1.21	1.08±0.83
Ⅲ型	25	50.64±3.35	5.92±2.60	2.84±1.18	0.92±0.86

表1 各型疝手术时间、术中出血量及术后疼痛评分资料

疝分型	例数	手术时间(min)	出血量(ml)	术后疼痛评分(分)
疝分型	例数	手术时间(min)	出血量(ml)	第1天	第7天
Ⅰ型	12	38.42±2.81	4.42±2.31	2.83±1.19	1.00±0.85
Ⅱ型	37	44.49±3.25	7.00±1.75	2.84±1.21	1.08±0.83
Ⅲ型	25	50.64±3.35	5.92±2.60	2.84±1.18	0.92±0.86

[1]	Reddy VM, Sutton CD, Bloxham L, et al. Laparoscopic repair of direct inguinal hernia: a new technique that reduces the development of postoperative seroma[J]. Hernia, 2007, 11(5): 393-396.
[2]	Copeland GP, Jones D, Walters M. POSSUM: a scoring system for surgical audit[J]. Br J Surg, 1991, 78(3): 355-360.
[3]	中华医学会外科学分会疝和腹壁外科学组. 成人腹股沟疝、股疝和腹部手术切口疝手术治疗方案(2003年修订稿)[J]. 中华外科杂志, 2004, 42(14): 834-835.
[4]	中华医学会外科学分会疝和腹壁外科学组，中华医学会外科学分会腹腔镜与内镜外科学组，大中华腔镜疝外科学院. 腹腔镜腹股沟疝手术操作指南(2017版)[J]. 中国实用外科杂志, 2017, 37(11): 1238-1242.
[5]	Morales-Conde S. A new classification for seroma after laparoscopic ventral hernia repair[J]. Hernia, 2012, 16(3): 261-267.
[6]	严广斌. 视觉模拟评分法[J/CD]. 中华关节外科杂志(电子版), 2014,(2): 34-34.
[7]	Classification of chronic pain. Descriptions of chronic pain syndromes and definitions of pain terms. Prepared by the International Association for the Study of Pain, Subcommittee on Taxonomy[J]. Pain Suppl, 1986, 3: S1-226.
[8]	Reiner MA, Bresnahan ER. Laparoscopic total extraperitoneal hernia repair outcomes[J]. JSLS, 2016, 20(3). pii: e2016. 00043.
[9]	Bittner R, Schwarz J. Inguinal hernia repair: current surgical techniques[J]. Langenbecks Arch Surg, 2012, 397(2): 271-282.
[10]	Bracale U, Melillo P, Pignata G, et al. Which is the best laparoscopic approach for inguinal hernia repair: TEP or TAPP? A systematic review of the literature with a network meta-analysis[J]. Surg Endosc, 2012, 26(12): 3355-3366.
[11]	唐健雄. 腹外疝手术治疗规范化实施与质量控制标准[J]. 中国实用外科杂志, 2014, 34(1): 55-58.
[12]	陈杰，那冬鸣，申英末. 局部神经阻滞麻醉下内置弹力记忆环(Kugel补片)的腹膜前无张力疝修补术[J]. 中华腹部疾病杂志, 2004, 4(12): 865-867.
[13]	Klink CD, Binnebösel M, Lucas AH, et al. Serum analyses for protein, albumin and IL-1-RA serve as reliable predictors for seroma formation after incisional hernia repair[J]. Hernia, 2011, 15(1): 69-73.
[14]	Gao D, Wei S, Zhai C, et al. Clinical research of preperitoneal drainage after endoscopic totally extraperitoneal inguinal hernia repair[J]. Hernia, 2015, 19(5): 789-794.
[15]	Birch DW. Characterizing laparoscopic incisional hernia repair[J]. Can J Surg, 2007, 50(3): 195-201.
[16]	Bittner R, Sauerland S, Schmedt CG. Comparison of endoscopic techniques vs Shouldice and other open nonmesh techniques for inguinal hernia repair: a meta-analysis of randomized controlled trials[J]. Surg Endosc, 2005, 19(5): 605-615.
[17]	Varnell B, Bachman S, Quick J, et al. Morbidity associated with laparoscopic repair of suprapubic hernias[J]. Am J Surg, 2008, 196(6): 983-987; discussion 987-988.
[18]	Andresen K, Bisgaard T, Rosenberg J. Sliding inguinal hernia is a risk factor for recurrence[J]. Langenbecks Arch Surg, 2015, 400(1): 101-106.
[19]	Kingsnorth A, Gingell-Littlejohn M, Nienhuijs S, et al. Randomized controlled multicenter international clinical trial of self-gripping Parietex™ ProGrip™ polyester mesh versus lightweight polypropylene mesh in open inguinal hernia repair: interim results at 3 months[J]. Hernia, 2012, 16(3): 287-294.
[20]	Ismail M, Garg M, Rajagopal M, et al. Impact of closed-suction drain in preperitoneal space on the incidence of seroma formation after laparoscopic total extraperitoneal inguinal hernia repair[J]. Surg Laparosc Endosc Percutan Tech, 2009, 19(3): 263-266.
[21]	Shpitz B, Kuriansky J, Werener M, et al. Early postoperative evaluation of groins after laparoscopic total extraperitoneal repair of inguinal hernias[J]. J Laparoendosc Adv Surg Tech A, 2004, 14(6): 353-357.
[22]	孙中伟，孙少川. 腹腔镜腹股沟疝修补术后血清肿预防与应对[J/CD]. 中华疝和腹壁外科杂志(电子版), 2018, 12(2): 144-146.
[23]	Berney CR. The Endoloop technique for the primary closure of direct inguinal hernia defect during the endoscopic totally extraperitoneal approach[J]. Hernia, 2012, 16(3): 301-305.
[24]	付焱，李恒. 腹腔镜腹股沟直疝修补术中假性疝囊处理的临床研究[J/CD]. 中华疝和腹壁外科杂志(电子版), 2019, 13(1): 58-61.

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