探讨腹腔镜经腹腹膜前腹股沟直疝修补术中疝环缝合关闭对预防术后血清肿形成的临床疗效。

前瞻性随机选择2017年1月至2019年12月于首都医科大学附属北京潞河医院普外科疝中心收治的154例行腹腔镜经腹腹膜前疝修补术（TAPP）腹股沟直疝患者。按照随机数字表法将患者随机分为试验组和对照组，每组77例。试验组给予关闭缺损组，术中将腹横筋膜关闭并固定于耻骨梳韧带或腹直肌下缘及腹壁坚韧组织或仅做疝环腹横筋膜的"十字"缝合关闭；对照组给予不关闭缺损组，术中对突出变薄的腹横筋膜予以旷置处理。比较2组患者手术情况及手术相关并发症情况，此外通过超声检查对2组患者术后血清肿发生的情况进行对比分析。

试验组和对照组的手术时间分别为（52.34±11.29）min和（46.33±7.96）min，差异有统计学意义（P<0.05）。2组患者术中和围手术期并发症情况比较的差异无统计学意义（P>0.05）。试验组和对照组术后1 d血清肿范围分别为（3.65±1.50）cm和（5.14±1.77）cm，术后7 d的血清肿直径分别为（2.66±1.24）cm和（3.51±1.36）cm，术后1个月血清肿发生率分别为12.99%和28.57%，术后3个月血清肿发生率分别为2.60%和5.19%，差异均有统计学意义（均P<0.05）。

腹腔镜经腹腹膜前腹股沟直疝修补术中通过缝合腹横筋膜关闭直疝缺损，尽管增加手术时间，但能够有效地降低术后血清肿的发生率，其安全性好，尤其对于较大的直疝而言效果显著，具有较高的可行性。

To investigate the clinical effect and application of hernia defect closure in the laparoscopic transabdominal preperitoneal (TAPP) direct inguinal hernia repair for the prevention of postoperative seroma formation.

A prospective randomized controlled study was conducted on 154 cases of direct inguinal hernia who underwent TAPP repair in Beijing Luhe hospital from January 2017 to December 2019. According to random grouping method, the patients were randomly assigned into the experimental group (closed defect group, closed and fixed transverse fascia to Cooper's ligament or lower edge of the rectus abdominis and tough tissue of abdominal wall, or only "cross" mattress suture of the transverse fascia) and control group (did not close the defect, separated the "false" hernial sac without any intervention). Compared two groups of patients with operation parameters and surgery related complications. In addition, the incidence of postoperative seroma in the two groups were examined by ultrasound and analyzed.

In terms of operation-related indicators, the operative time of the experimental group and the control group was (52.34±11.29) minutes vs (46.33±7.96) minutes, respectively, and the difference between the two groups was statistically significant (P<0.05). There were no statistically significant differences in the intraoperative and preoperative complications between the two groups (P>0.05). In terms of seroma, the range of postoperative seroma in the experimental group and the control group was (3.65±1.50) cm vs (5.14±1.77) cm, and (2.66±1.24) cm vs (3.51±1.36) cm, respectively, on the 1st day and 7th day after surgery. The differences between the two groups were statistically significant. In the follow-up period, the seroma incidence of the experimental group and the control group at 1 month and 3 months after surgery was 12.99% vs 28.57% and 2.60% vs 5.19%, respectively. The seroma incidence of the experimental group was also significantly lower than that of the control group, with statistical significance (P<0.05).

In laparoscopic transabdominal preperitoneal direct inguinal hernia repair, the closure of direct hernia defect by suturing the transverse fascia can effectively reduce the incidence of postoperative seroma. Although the operation time is increased, it is safe and effective, especially for large direct hernia.