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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) ›› 2022, Vol. 16 ›› Issue (03) : 317 -320. doi: 10.3877/cma.j.issn.1674-392X.2022.03.016

临床论著

腹腔镜经腹腹膜前疝修补镜下层面解剖的应用
唐迎泉1,†(), 李键2, 张建兴2, 李应军2, 向进见1   
  1. 1. 434000　湖北省，长江大学附属第一医院荆州市第一人民医院胃肠外科
    2. 518104　深圳市中西医结合医院胃肠外科
  • 收稿日期:2021-09-03 出版日期:2022-06-20
  • 通信作者: 唐迎泉

Application of sectional anatomy in laparoscopic trans-abdominal preperitoneal hernia repair

Yingquan Tang1,†(), Jian Li2, Jianxing Zhang2, Yingjun Li2, Jinjian Xiang1   

  1. 1. Department of Gastrointestinal Surgery, The First Affiliated Hospital of Yangtze University Jingzhou First People's Hospital, Jingzhou 434000, Hubei Province, China
    2. Department of Gastrointestinal Surgery, Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine, Shenzhen 518104, China
  • Received:2021-09-03 Published:2022-06-20
  • Corresponding author: Yingquan Tang
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引用本文：

唐迎泉, 李键, 张建兴, 李应军, 向进见. 腹腔镜经腹腹膜前疝修补镜下层面解剖的应用[J]. 中华疝和腹壁外科杂志(电子版), 2022, 16(03): 317-320.

Yingquan Tang, Jian Li, Jianxing Zhang, Yingjun Li, Jinjian Xiang. Application of sectional anatomy in laparoscopic trans-abdominal preperitoneal hernia repair[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2022, 16(03): 317-320.

目的

探讨层面解剖在腹腔镜经腹腹膜前疝修补术（TAPP）中的应用。

方法

选取2018年8月至2020年1月于长江大学附属第一医院荆州市第一人民医院收治的腹股沟疝患者50例，通过随机数表法将其分为对照组和观察组，各25例。对照组采用常规TAPP术治疗，观察组采用结合层面解剖技术的TAPP术治疗。比较2组患者的手术指标（术中出血量、手术时间和住院时间）、疼痛视觉模拟评分（VAS）、并发症（血清肿、膀胱表面血管损伤、腹膜损伤和复发）以及生活质量[包括生理功能（PF）、生理职能（RP）、躯体疼痛（BP）、整体健康（GH）、活力状况（VT）、社会功能（SF）、情感职能（RE）以及精神健康（MH）等8个维度]等情况。

结果

观察组患者的术中出血量、住院时间等手术指标均显著低于对照组（P<0.05），2组患者手术时间无明显差异（P>0.05）；观察组患者术后第1天、第5天的VAS评分均显著低于对照组（P<0.05）；观察组患者膀胱表面血管损伤发生率、复发率与对照组比较均无明显差异（P>0.05），血清肿、腹膜破损发生率显著低于对照组（P<0.05）；观察组患者在PF、RP、BP、GH、VT、SF、RE以及MH等8个维度的生活质量评分均显著高于对照组（P<0.05）。

结论

将层面解剖技术结合TAPP治疗腹股沟疝患者效果显著，降低了并发症发生率，显著减轻患者痛苦，提高其生活质量。

关键词: 疝，腹股沟, 腹腔镜, 疝修补术, 层面解剖
Objective

To explore the application of sectional anatomy for trans-abdominal preperitoneal hernia repair (TAPP).

Methods

Fifty patients with inguinal hernia admitted to the First Affiliated Hospital of Yangtze University Jingzhou First People's Hospital from August 2018 to January 2020 were selected and divided into the control group and the observation group by the random number table method, with 25 patients in each group. The control group was treated with conventional TAPP, while the observation group was treated with TAPP combined with sectional anatomy. Surgical indicators (intraoperative blood loss, operation time and hospitalization time), visual analogue scale (VAS) score, complications (seroma, damage of blood vessels on the surface of bladder, the injury of peritoneal and recurrence), and the quality of life [including 8 dimensions: physiological function (PF), role physical (RP), body pain (BP), general health (GH), vitality (VT), social function (SF), role emotional (RE), and mental health (MH)] of the patients in the two groups were compared.

Results

The intraoperative blood loss and length of hospitalization time in the observation group were significantly lower than those in the control group (P<0.05), and there was no significant difference in operation time between the two groups (P>0.05). The VAS scores in the observation group on the 1st and 5th day after the surgery were significantly lower than those in the control group (P<0.05). There was no statistically significant difference in the incidence of damage of blood vessels on the surface of bladder and recurrence between the observation group and the control group (P>0.05), and the incidence of seroma and peritoneal damage in the observation group was significantly lower than that in the control group (P<0.05). The 8 dimensions quality of life scores of PF, RP, BP, GH, VT, SF, RE and MH in the observation group were significantly higher than those in the control group (P<0.05).

Conclusion

The application of sectional anatomy technique combined with TAPP in the treatment of inguinal hernia has a significant effect, which can reduce the incidence of complications and the pain of patients, and improve their quality of life.

Key words: Hernia, inguinal, Laparoscopes, Herniorrhaphy, Sectional anatomy
表1 2组患者手术指标比较（±s）
组别 例数 术中出血量(ml) 手术时间(min) 住院时间(d)
对照组 25 12.16±0.43 43.42±4.91 6.19±0.64
观察组 25 10.73±0.57 45.83±4.72 5.36±0.33
t值   10.014 1.769 5.763
P值   <0.001 0.083 <0.001
表2 2组患者术后疼痛视觉模拟评分比较（分，±s）
组别 例数 术后1 d 术后5 d
对照组 25 5.48±0.63 2.83±0.59
观察组 25 4.62±0.29 1.02±0.37
t值   6.200 12.995
P值   <0.001 <0.001
表3 2组患者并发症及6个月复发比较[例（%）]
组别 例数 血清肿 膀胱表面血管损伤 腹膜破损 复发
对照组 25 9(36.00) 3(12.00) 8(32.00) 1(4.00)
观察组 25 2(8.00) 1(4.00) 2(8.00) 1(4.00)
χ2值   5.711 0.272 4.50 0.521
P值   0.017 0.602 0.034 0.470
表4 2组患者生活质量比较（分，±s）
组别 例数 生理功能 生理职能 躯体疼痛 整体健康 活力状况 社会功能 情感职能 精神健康
对照组 25 80.73±7.62 76.83±7.47 73.52±10.98 70.52±11.53 73.82±9.61 79.62±8.17 77.36±12.61 77.62±9.54
观察组 25 87.56±8.91 85.61±6.73 82.69±12.36 81.62±12.67 79.52±9.28 85.56±9.77 84.57±10.45 83.23±8.95
t值   2.913 4.366 2.773 3.240 2.133 2.332 2.201 2.144
P值   0.005 <0.001 0.008 0.002 0.038 0.024 0.033 0.037
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