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) : 300 -303. doi: 10.3877/cma.j.issn.1674-392X.2021.03.022

临床论著

腹腔镜经腹腹膜前疝修补术中不同疝囊处理方式的对比研究
黄文海1, 姜笑明1,†()   
  1. 1. 复旦大学附属金山医院普外科
  • 收稿日期:2020-03-05 出版日期:2021-06-18
  • 通信作者: 姜笑明

A controlled study of different hernia sac management in laparoscopic transabdominal preperitoneal procedure for indirect inguinal hernia

Wenhai Huang1, Xiaoming Jiang1,†()   

  1. 1. Department of General Surgery, Jinshan Hospital of Fudan University, Shanghai 201508, China
  • Received:2020-03-05 Published:2021-06-18
  • Corresponding author: Xiaoming Jiang
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

黄文海, 姜笑明. 腹腔镜经腹腹膜前疝修补术中不同疝囊处理方式的对比研究[J/OL]. 中华疝和腹壁外科杂志(电子版), 2021, 15(03): 300-303.

Wenhai Huang, Xiaoming Jiang. A controlled study of different hernia sac management in laparoscopic transabdominal preperitoneal procedure for indirect inguinal hernia[J/OL]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2021, 15(03): 300-303.

目的

对比分析腹腔镜经腹腹膜前疝修补术（TAPP）在治疗腹股沟斜疝中不同疝囊处理方式对手术并发症的影响。

方法

收集2017年1月至2019年1月复旦大学附属金山医院收治的原发性腹股沟斜疝患者80例，分为试验组和对照组，每组患者40例。试验组术中横断斜疝疝囊，对照组术中完全还纳疝囊。对比2组疝囊处理时间、手术时间、术后血肿发生率、血清肿发生率、急性疼痛发生率、慢性疼痛发生率、住院时间、复发率和其他并发症情况。

结果

疝囊处理时间方面，试验组明显短于对照组[（9.2±3.42）min比（26.7±8.93 min），P<0.01]；2组的手术时间分别为（42.2±4.33）min和（59.0±8.44）min，差异有统计学意义（P<0.01）。2组患者的术后住院时间无显著差异。2组患者的血肿发生率、血清肿发生率、急性疼痛发生率、慢性疼痛发生率和复发率方面没有统计学差异。

结论

TAPP治疗腹股沟斜疝时疝囊横断减少了操作时间，不增加血清肿、急性或慢性疼痛等并发症发生率。

关键词: 腹股沟斜疝, 腹腔镜, 疝囊, 血清肿, 疼痛, 复发
Objective

To compare the effects of different treatment methods of hernia sac on surgical complications of laparoscopic transabdominal preperitoneal (TAPP) repair in the treatment of indirect inguinal hernia.

Methods

A total of 80 patients with primary indirect inguinal hernia admitted to Jinshan Hospital of Fudan University from January 2017 to January 2019 were collected and divided into experimental group and control group, with 40 cases in each group. Intraoperative transection of the indirect hernia sac was performed in the experimental group, and complete restoration of the hernia sac was performed in the control group. The treatment time of hernia sac, operative time, incidence of postoperative hematoma, seroma, acute pain, chronic pain, length of hospital stay, recurrence rate and other complications were compared between the two groups.

Results

The treatment time of hernia sac in the experimental group was significantly shorter than that in the control group [(9.2±3.42) minutes vs (26.7±8.93) minutes, P<0.01]. The operative time of the two groups was (42.2±4.33) minutes and (59.0±8.44) minutes, respectively (P<0.01). There was no significant difference in length of postoperative hospital stay between the two groups. In terms of follow-up, there were no statistically significant differences in the incidence of hematoma, seroma, acute pain, chronic pain, and recurrence between the two groups.

Conclusion

Transection of hernia sac in laparoscopic transabdominal preperitoneal procedure for indirect inguinal hernia reduces the operation time and does not increase the incidence of complications such as seroma, acute or chronic pain.

Key words: Hernia,inguinal, Laparoscope, Hernia sac, Seroma, Pain, Recurrence
表1 2组患者的一般资料比较
变量 试验组(40例) 对照组(40例) P值
性别     0.164
  男性 37(92.50) 38(95.00)
  女性 3(7.50) 2(5.00)
年龄 59.32±8.77 60.14±8.43 0.272
BMI(kg/m2) 18.9±3.1 19.1±3.0 0.209
疝位置     0.339
  左侧 12(30.00) 13(32.50)
  右侧 21(52.50) 22(55.00)
  双侧 7(17.50) 5(12.50)
疝缺损大小(cm)     0.129
  >3 12(30.00) 14(35.00)
  <3 28(70.00) 26(65.00)
ASA分级     0.063
  Ⅰ级 24(60.00) 22(55.00)
  Ⅱ级 16(40.00) 18(45.00)
随访时间(个月) 12.2±0.5 12.4±0.2 0.345
图1 入选病例资料及结果
表2 2组患者临床资料比较
变量 试验组(40例) 对照组(40例) P值
疝囊处理时间(min, ±s) 9.2±3.42 26.7±8.93 0.001
手术时间(min, ±s) 42.2±4.33 59.0±8.44 0.001
住院时间(d, ±s) 2.5±1.15 2.8±1.29 0.156
急性疼痛[例(%)] 2(2.22) 3(3.33) 0.121
血肿[例(%)] 1(1.11) 1(1.11) 0.899
血清肿[例(%)]      
  1周 6(15.00) 7(17.50) 0.066
  1个月 3(7.50) 4(10.00) 0.104
  3个月 1(2.50) 2(5.00) 0.070
慢性疼痛[例(%)] 1(1.11) 2(2.22) 0.299
复发[例(%)] 0 0 -
[1]
唐健雄，李绍杰，黄磊. 我国腹股沟疝手术规范化和质量控制存在的问题及对策[J]. 中国实用外科杂志, 2018, 38(1): 72-74.
[2]
Ielpo B, Nuñez-Alfonsel J, Duran H, et al. Cost-effectiveness of randomized study of laparoscopic versus open bilateral inguinal hernia repair[J]. Ann Surg, 2018, 268(5): 725-730.
[3]
Group HS. International guidelines for groin hernia management[J]. Hernia, 2018, 22(1): 1-165.
[4]
Bittner R, Schwarz J. Primary unilateral not complicated inguinal hernia: our choice of TAPP, why, results and review of literature[J]. Hernia, 2019, 23(1): 417-428.
[5]
Jin C, Shen Y, Chen J, et al. Surgery for incarcerated inguinal hernia: outcomes with Lichtenstein versus open preperitoneal approach [J]. Int J Abdom Wall Hernia Surg, 2019, 2: 44-49.
[6]
Bellows CF, Shadduck P, Helton WS, et al. Early report of a randomized comparative clinical trial of Strattice? Reconstructive tissue matrix to lightweight synthetic mesh in the repair of inguinal hernias [J]. Hernia, 2014, 18(2): 221-230.
[7]
Yeseul Park, Ralph WA, Jeffrey R, et al. Laparoscopic Hill repair: 25- year follow-up[J]. Surg Endosc, 2018, 32(10): 4111-4115.
[8]
Zhu Y, Liu M, Li J et al. Closure of direct inguinal hernia defect in laparoscopic hernioplasty to prevent seroma formation: a prospective double-blind randomized controlled trial[J]. Surg Laparosc Endosc Percutaneous Tech, 2019, 29(1): 18-21.
[9]
Kockerling F, Bittnerz R, Adolf D, et al. Seroma following transabdominalpreperitoneal patch plasty(TAPP): incidence, risk factors, and preventive measures[J]. Surg Endo, 2018, 32(5): 2222-2231.
[10]
Bay-Nielsen M, Kehlet H, Strand L, et al. Quality assessment of 26 304 herniorrhaphies in Denmark: a prospective nationwide study[J]. Lancet, 2001, 358(9288), 1124-1128.
[11]
Umberto B, Giovanni M, Antonio S, et al. Achieving the learning curve in laparoscopic inguinal hernia repair by tapp: a quality improvement study[J]. J Investig Surg, 2019, 32(8): 738-745.
[12]
李俊生，邵翔宇，程韬, 等. 腹腔镜腹股沟疝修补术后浆液肿的预防措施[J/OL]. 中华疝和腹壁外科杂志(电子版), 2019, 13(1): 6-9.
[13]
Daes J. Endoscopic repair of large inguinoscrotal hernias: management of the distal sac to avoid seroma formation[J]. Hernia, 2014, 18(1): 119-122.
[14]
Liu Y, Zhou M, Zhu X, et al. Risk and protective factors for chronic pain following inguinal hernia repair: a retrospective study[J]. J Anesth, 2020, 34(3): 330-337.
[1] 燕速, 霍博文. 腹腔镜食管胃结合部腺癌根治性切除术[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 13-13.
[2] 母德安, 李凯, 张志远, 张伟. 超微创器械辅助单孔腹腔镜下脾部分切除术[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 14-14.
[3] 李国新, 陈新华. 全腹腔镜下全胃切除术食管空肠吻合的临床研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 1-4.
[4] 李子禹, 卢信星, 李双喜, 陕飞. 食管胃结合部腺癌腹腔镜手术重建方式的选择[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 5-8.
[5] 李乐平, 张荣华, 商亮. 腹腔镜食管胃结合部腺癌根治淋巴结清扫策略[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 9-12.
[6] 陈方鹏, 杨大伟, 金从稳. 腹腔镜近端胃癌切除术联合改良食管胃吻合术重建His角对术后反流性食管炎的效果研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 15-18.
[7] 许杰, 李亚俊, 韩军伟. 两种入路下腹腔镜根治性全胃切除术治疗超重胃癌的效果比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 19-22.
[8] 李刘庆, 陈小翔, 吕成余. 全腹腔镜与腹腔镜辅助远端胃癌根治术治疗进展期胃癌的近中期随访比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 23-26.
[9] 刘世君, 马杰, 师鲁静. 胃癌完整系膜切除术+标准D2根治术治疗进展期胃癌的近中期随访研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 27-30.
[10] 王庆亮, 党兮, 师凯, 刘波. 腹腔镜联合胆道子镜经胆囊管胆总管探查取石术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 313-313.
[11] 杨建辉, 段文斌, 马忠志, 卿宇豪. 腹腔镜下脾部分切除术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 314-314.
[12] 叶劲松, 刘驳强, 柳胜君, 吴浩然. 腹腔镜肝Ⅶ+Ⅷ段背侧段切除[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 315-315.
[13] 郭兵, 王万里, 何凯, 黄汉生. 腹腔镜下肝门部胆管癌根治术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(01): 143-143.
[14] 李凯, 陈淋, 苏怀东, 向涵, 张伟. 超微创器械在改良单孔腹腔镜巨大肝囊肿开窗引流及胆囊切除中的应用[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(01): 144-144.
[15] 魏丽霞, 张安澜, 周宝勇, 李明. 腹腔镜下Ⅲb型肝门部胆管癌根治术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(01): 145-145.
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