切换至 "中华医学电子期刊资源库"
高级检索
中华疝和腹壁外科杂志(电子版)

中华疝和腹壁外科杂志(电子版) ›› 2021, Vol. 15 ›› Issue (03) : 223 -227. doi: 10.3877/cma.j.issn.1674-392X.2021.03.003

临床论著

腹腔镜腹股沟直疝修补术疝环缺损关闭对预防血清肿的效果分析
田广健1, 刘鹏1, 杨佩1, 赵鑫1, 韩威1,†()   
  1. 1. 101149　首都医科大学附属北京潞河医院普外科
  • 收稿日期:2020-03-02 出版日期:2021-06-18
  • 通信作者: 韩威

Effect of closure of hernia defect in laparoscopic direct inguinal hernia repair on the prevention of seroma

Guangjian Tian1, Peng Liu1, Pei Yang1, Xin Zhao1, Wei Han1,†()   

  1. 1. Department of General Surgery, Beijing Luhe Hospital, Capital Medical University, Beijing 101149, China
  • Received:2020-03-02 Published:2021-06-18
  • Corresponding author: Wei Han
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

田广健, 刘鹏, 杨佩, 赵鑫, 韩威. 腹腔镜腹股沟直疝修补术疝环缺损关闭对预防血清肿的效果分析[J]. 中华疝和腹壁外科杂志(电子版), 2021, 15(03): 223-227.

Guangjian Tian, Peng Liu, Pei Yang, Xin Zhao, Wei Han. Effect of closure of hernia defect in laparoscopic direct inguinal hernia repair on the prevention of seroma[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2021, 15(03): 223-227.

目的

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。

方法

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。

结果

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）。

结论

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。

关键词: 腹股沟,直疝, 腹腔镜, 缝合, 血清肿
Objective

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.

Methods

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.

Results

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).

Conclusion

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.

Key words: Inguinal, direct hernia, Laparoscopes, Suture, Seroma
图1 腹腔镜经腹腹膜前疝修补术
表1 2组患者基线资料对比情况
项目 试验组(77例) 对照组(77例) P值
年龄(岁, ±s) 59.57±10.76 60.93±9.99 >0.05
BMI(kg/m2, ±s) 18.3±2.17 18.8±2.21 >0.05
性别[例(%)]     >0.05
  男性 73(94.81) 74(96.10)  
  女性 4(5.19) 3(3.90)  
ASA分级[例(%)]     >0.05
  Ⅰ级 36(46.75) 39(50.65)  
  Ⅱ级 41(53.25) 38(49.35)  
疝位置[例(%)]     >0.05
  单侧 52(67.53) 49(63.64)  
  双侧 25(32.47) 28(36.36)  
Gilbert分型[例(%)]     >0.05
  Ⅳ型 31(40.26) 33(42.86)  
  Ⅴ型 46(59.74) 44(57.14)  
疝环直径(cm, ±s) 2.99±0.46 2.87±0.44 >0.05
表2 2组患者手术和围手术期资料对比情况
项目 试验组(77例) 对照组(77例) P值
术中[例(%)] 0 0 -
血管损伤 0 0 -
输精管损伤 0 0 -
精索损伤 0 0 -
肠管损伤 0 0 -
膀胱损伤 0 0 -
围手术期[例(%)] 6(7.79) 5(6.49) >0.05
急性疼痛 2(2.60) 1(1.30) -
尿潴留 0 0 -
认知功能障碍 0 0 -
静脉血栓栓塞症 0 0 -
发热 4(5.19) 4(5.19) -
术后住院时间(d, ±s) 2.16±0.59 2.21±0.55 >0.05
手术时间(min, ±s) 52.34±11.29 46.33±7.96 <0.05
表3 2组患者血清肿及随访期情况比较
项目 试验组(77例) 对照组(77例) P值
血清肿直径(cm, ±s)      
术后1 d 3.65±1.50 5.14±1.77 <0.05
术后7 d 2.66±1.24 3.51±1.36 <0.05
血清肿发生率[例(%)]      
术后1个月 10(12.99) 22(28.57) <0.05
术后3个月 2(2.60) 4(5.19) <0.05
随访时间(个月, ±s) 11.9±0.43 11.8±0.41 >0.05
复发[例(%)] 0 0 -
感染[例(%)] 0 0 -
慢性疼痛[例(%)] 0 0 -
[1]
Reiner MA, Bresnahan ER. Laparoscopic total extraperitoneal hernia repair outcomes[J]. JSLS, 2016, 20(3): e2016.00043.
[2]
Tandon A, Pathak S, Lyons NJR, et al. Meta-analysis of closure of the fascial defect during laparoscopic incisional and ventral hernia repair[J]. Br J Surg, 2016, 103(12): 1598-1607.
[3]
Li J, Gong W, Liu Q. Intraoperative adjunctive techniques to reduce seroma formation in laparoscopic inguinal hernioplasty: a systematic review[J]. Hernia, 2019, 23(4): 723-731.
[4]
Bittner R, Arregui ME, Bisgaard T, et al. Guidelines for laparoscopic (TAPP) and endoscopic(TEP) treatment of inguinal hernia[J]. Surg Endosc, 2012, 25: 2773-2843.
[5]
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.
[6]
Gilbert AI. Hernia repair in the aged and infirmed[J]. J Fla Med Assoc, 1988, 75(11): 742.
[7]
Köckerling F, Simons MP. Current Concepts of Inguinal Hernia Repair[J]. Visc Med, 2018, 34(2): 145-150.
[8]
Köckerling F, Bittner R, Jacob DA, et al. TEP versus TAPP: comparison of the perioperative outcome in 17, 587 patients with a primary unilateral inguinal hernia[J]. Surg Endosc, 2015, 29(12): 3750-3760.
[9]
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.
[10]
Lau H, Lee F. Seroma following endoscopic extraperitoneal inguinal hernioplasty[J]. Surg Endosc, 2003, 17(11): 1773-1777.
[11]
Misra MC, Bhowate PD, Bansal VK, et al. Massive scrotal hernias: problems and solutions[J]. J Laparoendosc Adv Surg Tech A, 2009, 19(1): 19-22.
[12]
Cihan A, Ozdemir H, Uçan BH, et al. Fade or fate. Seroma in laparoscopic inguinal hernia repair[J]. Surg Endosc, 2006, 20(2): 325-328.
[13]
Belyansky I, Daes J, Radu VG, et al. A novel approach using the enhanced-view totally extraperitoneal(eTEP) technique for laparoscopic retromuscular hernia repair[J]. Surg Endosc, 2018, 32(3): 1525-1532.
[14]
Janis JE, Khansa L, Khansa I. Strategies for postoperative seroma prevention: a systematic review[J]. Plast Reconstr Surg, 2016, 138(1): 240-252.
[15]
Elango S, Perumalsamy S, Ramachandran K, et al. Mesh materials and hernia repair[J]. Biomedicine, 2017, 7(3): 16.
[16]
Papageorge CM, Funk LM, Poulose BK, et al. Primary fascial closure during laparoscopic ventral hernia repair does not reduce 30-day wound complications[J]. Surg Endosc, 2017, 31(11): 4551-4557.
[17]
Morales-Conde S. A new classification for seroma after laparoscopic ventral hernia repair[J]. Hernia, 2012, 16(3): 261-267.
[18]
Fan JKM, Liu J, Chen K, et al. Preperitoneal closed-system suction drainage after totally extraperitoneal hernioplasty in the prevention of early seroma formation: a prospective double-blind randomised controlled trial[J]. Hernia, 2018, 22(3): 455-465.
[19]
刘星伟，莫湘琼，苏永辉, 等. 经腹白线穿刺处理腹股沟直疝假疝囊在腹腔镜腹股沟疝手术中的应用[J/OL]. 中华疝和腹壁外科杂志(电子版), 2020, 14(4): 96-99.
[20]
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/OL]. 中华疝和腹壁外科杂志(电子版), 2019, 13(1): 64-67.
[21]
Li J, Zhang W. Closure of a direct inguinal hernia defect in laparoscopic repair with barbed suture: a simple method to prevent seroma formation?[J]. Surg Endosc, 2018, 32(2): 1082-1086.
[1] 李凯, 陈淋, 向涵, 苏怀东, 张伟. 一种U型记忆合金线在经脐单孔腹腔镜阑尾切除术中的临床应用[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 15-15.
[2] 曹迪, 张玉茹. 经腹腔镜生物补片修补直肠癌根治术后盆底疝1例[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 115-116.
[3] 杜晓辉, 崔建新. 腹腔镜右半结肠癌D3根治术淋巴结清扫范围与策略[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 5-8.
[4] 周岩冰, 刘晓东. 腹腔镜右半结肠癌D3根治术消化道吻合重建方式的选择[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 9-13.
[5] 张焱辉, 张蛟, 朱志贤. 留置肛管在中低位直肠癌新辅助放化疗后腹腔镜TME术中的临床研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 25-28.
[6] 王春荣, 陈姜, 喻晨. 循Glisson蒂鞘外解剖、Laennec膜入路腹腔镜解剖性左半肝切除术临床应用[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 37-40.
[7] 李晓玉, 江庆, 汤海琴, 罗静枝. 围手术期综合管理对胆总管结石并急性胆管炎患者ERCP +LC术后心肌损伤的影响研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 57-60.
[8] 甄子铂, 刘金虎. 基于列线图模型探究静脉全身麻醉腹腔镜胆囊切除术患者术后肠道功能紊乱的影响因素[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 61-65.
[9] 逄世江, 黄艳艳, 朱冠烈. 改良π形吻合在腹腔镜全胃切除消化道重建中的安全性和有效性研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 66-69.
[10] 易明超, 汪鑫, 向涵, 苏怀东, 张伟. 一种T型记忆金属线在经脐单孔腹腔镜胆囊切除术中的临床应用[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 599-599.
[11] 李三祥, 李佳, 刘俊峰, 吕东晨, 方晖东, 谭朝晖, 刘杰, 潘佐, 乔建坤. 基于CT影像的三维重建成像技术在腹腔镜大肾上腺肿瘤切除术中的应用[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(06): 570-574.
[12] 赵佳晖, 王永兴, 彭涛, 李明川, 魏德超, 韩毅力, 侯铸, 姜永光, 罗勇. 后腹腔镜根治性肾切除手术时间延长和术中出血量增多的影响因素分析[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(06): 575-580.
[13] 汪帮琦, 陈波特, 林浩坚, 许晖阳, 王镇伟, 袁雪峰, 林康健, 邱晓拂. 经腹入路3D腹腔镜联合输尿管硬镜同期处理肾盂输尿管连接部梗阻并肾盏结石的应用[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(06): 597-600.
[14] 林文斌, 郑泽源, 郑文能, 郁毅刚. 外伤性脾破裂腹腔镜脾切除术患者中转开腹风险预测模型构建[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 619-623.
[15] 牛朝, 李波, 张万福, 靳文帝, 王春晓, 李晓刚. 腹腔镜袖状胃切除联合胆囊切除治疗肥胖合并胆囊结石安全性和疗效[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 635-639.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号