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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 (06) : 628 -631. doi: 10.3877/cma.j.issn.1674-392X.2021.06.021

临床论著

腹腔镜完全腹膜外疝修补术中保留子宫圆韧带的临床价值
陈亮1, 张升敏1, 马克强1,†(), 王晓龙1, 曹洪涛1, 邹来宾1, 嵇腾飞1, 罗玉媚1, 由田1, 任国亮2   
  1. 1. 510800　广州市花都区人民医院胃肠外科
    2. 810001　西宁，青海红十字医院胃肠外科
  • 收稿日期:2020-04-29 出版日期:2021-12-20
  • 通信作者: 马克强
  • 基金资助:
    南方医科大学附属花都医院科研资金(2019B03)

Clinical value of preserving round ligament of uterus during laparoscopic totally extraperitoneal hernia repair

Liang Chen1, Shenmin Zhang1, Keqiang Ma1,†(), Xiaolong Wang1, Hongtao Cao1, Laibin Zou1, Tengfei Ji1, Yumei Luo1, Tian You1, Guoliang Ren2   

  1. 1. Department of Gastrointestinal Surgery, Huadu District People's Hospital, Southern Medical University, Guangzhou, Guangdong 510800, China
    2. Department of Gastrointestinal Surgery, Qinghai Provincial Red Cross Hospita, Xining 810001, China
  • Received:2020-04-29 Published:2021-12-20
  • Corresponding author: Keqiang Ma
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陈亮, 张升敏, 马克强, 王晓龙, 曹洪涛, 邹来宾, 嵇腾飞, 罗玉媚, 由田, 任国亮. 腹腔镜完全腹膜外疝修补术中保留子宫圆韧带的临床价值[J]. 中华疝和腹壁外科杂志(电子版), 2021, 15(06): 628-631.

Liang Chen, Shenmin Zhang, Keqiang Ma, Xiaolong Wang, Hongtao Cao, Laibin Zou, Tengfei Ji, Yumei Luo, Tian You, Guoliang Ren. Clinical value of preserving round ligament of uterus during laparoscopic totally extraperitoneal hernia repair[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2021, 15(06): 628-631.

目的

探讨腹腔镜完全腹膜外疝修补术（TEP）术中保留子宫圆韧带在成年女性中的应用价值。

方法

采用横断面随机对照回顾性研究，选择2015年9月到2019年3月在青海省红十字医院和广州市花都区人民医院诊治的腹股沟疝成年女性60例，根据随机数字表法分为保留组与对照组，每组30例。所有患者都行TEP术式，对照组术中不保留子宫圆韧带，保留组术中保留子宫圆韧带，记录与随访2组预后情况。

结果

保留组的术后住院时间、术后胃肠功能恢复时间、术后下床活动时间显著少于对照组，差异均有统计学意义（P<0.05）。保留组术后12、24、36 h的疼痛视觉模拟评分法均显著低于对照组，差异均有统计学意义（P<0.05）。保留组术后7 d并发症发生率为6.7%，显著低于对照组的26.7%，差异有统计学意义（P<0.05）。与术前1 d相比，术后7 d时2组血清抗苗勒管激素（AMH）水平更低，C1q/肿瘤坏死因子相关蛋白12（CTRP12）水平更高（P<0.05）。

结论

在成年女性中应用腹腔镜TEP中保留子宫圆韧带并不增加手术难度，且能缓解术后疼痛，减少术后并发症的发生，降低血清AMH水平与提高CTRP12水平，促进患者的康复。

关键词: 疝，腹股沟, 完全腹膜外补片修补术, 成年女性, 子宫圆韧带
Objective

To explore the value of retaining the uterine round ligament in adult women during laparoscopic totally extraperitoneal hernia repair (TEP).

Methods

A randomized controlled study was performed. From September 2015 to March 2019, 60 cases of adult women with inguinal hernia diagnosed and treated in Qinghai Provincial Red Cross Hospital and Guangzhou Huadu District People's Hospital were selected, and were divided into retention group and a control group with 30 cases in each group according to the random number table method. All patients underwent TEP repair. The control group not retained the uterine round ligament during the operation and the retention group retained the uterine round ligament during the operation. The outcomes of the two groups were recorded and followed up.

Results

The postoperative hospital stay, the recovery time of gastrointestinal function and the postoperative ambulation time in the retention group were significantly less than in the control group (P<0.05). The visual analogue scores of pain in the retention group at 12, 24 and 36 h after surgery were significantly lower than those in the control group (P<0.05). The incidence of complications of 7 days after operation in the retention group (6.7%) were significantly lower than that in the control group (26.7%) (P<0.05). The serum anti-Müllerian hormone (AMH) level of 7 days after operation in both groups were lower than that of 1 day before operation, and the serum CTRP12 level were higher than that of 1 day before operation (P<0.05).

Conclusion

Laparoscopic totally extraperitoneal hernia repair retaining the round ligament of uterine does not increase the difficulty of surgery in the adult women, and can relieve postoperative pain, reduce postoperative complications, reduce serum AMH levels and increase CTRP12 Level, promote the rehabilitation of patients.

Key words: Hernia, inguinal, Totally extraperitoneal hernia repair, Adult female, Round ligament of uterus
表1 2组腹腔镜完全腹膜外疝修补术术女性患者一般资料比较
组别 例数 发病类型(例) 临床分型(例) 年龄(岁, ±s ) 体质量指数(kg/m2, ±s ) 病程(个月, ±s )
斜疝 直疝 Ⅰ Ⅱ Ⅲ
保留组 30 29 1 11 12 7 26.92±2.19 22.76±1.48 21.98±2.14
对照组 30 28 2 12 12 6 27.00±1.84 22.19±1.11 22.09±1.74
统计值   0.351 0.120 0.133 0.672 0.126
P值   0.554 0.942 0.892 0.478 0.899
图2 腹腔镜下放置补片
表2 2组围手术指标比较（±s）
组别 例数 手术时间(min) 术中出血量(ml) 术后下床活动时间(h) 术后胃肠功能恢复时间(h) 术后住院时间(d)
保留组 30 44.25±1.48 34.20±4.10 33.28±3.24 12.87±0.55 2.78±0.44
对照组 30 44.19±2.00 34.89±3.14 43.76±2.17 16.76±1.77 4.17±0.17
t值   0.102 0.724 10.777 8.772 8.661
P值   0.934 0.398 <0.001 0.001 0.002
表3 2组术后不同时间点的疼痛评分对比（分，±s）
组别 例数 12 h 24 h 36 h
保留组 30 2.76±0.44 1.73±0.09 0.78±0.14
对照组 30 5.66±0.24 3.29±0.11 2.11±0.29
t值   9.382 8.224 10.932
P值   <0.001 0.002 <0.001
表4 2组手术前后血清AMH与CTRP12变化对比（±s）
组别 例数 AMH(ng/ml)治疗前 治疗后 t值 P值 CTRP12(pg/ml)治疗前 治疗后 t值 P值
保留组 30 10.45±2.19 3.65±0.11 19.013 <0.001 102.49±22.84 143.92±10.48 23.991 <0.001
对照组 30 10.99±1.48 6.78±0.49 11.848 <0.001 100.84±31.39 126.09±15.11 11.583 <0.001
t值   0.343 8.013     0.294 11.944    
P值   0.782 0.004     0.813 <0.001    
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