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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 (06) : 677 -681. doi: 10.3877/cma.j.issn.1674-392X.2022.06.015

临床论著

自制单孔通道在成人腹股沟疝腹腔镜手术中的应用评价
王霄1, 苏永辉1, 张百萌1, 刘星伟1,†()   
  1. 1. 519000　广东珠海，中山大学附属第五医院胃肠外科
  • 收稿日期:2022-01-13 出版日期:2022-12-18
  • 通信作者: 刘星伟

Evaluation of single-incision laparoscopic totally extra-peritoneal hernia repair by self-made path in adults with inguinal hernia

Xiao Wang1, Yonghui Su1, Baimeng Zhang1, Xingwei Liu1,†()   

  1. 1. Department of Gastrointestinal Surgery, The Fifth Affiliated Hospital of Sun Yat Sen University, Zhuhai, Guangdong 519000, China
  • Received:2022-01-13 Published:2022-12-18
  • Corresponding author: Xingwei Liu
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王霄, 苏永辉, 张百萌, 刘星伟. 自制单孔通道在成人腹股沟疝腹腔镜手术中的应用评价[J]. 中华疝和腹壁外科杂志(电子版), 2022, 16(06): 677-681.

Xiao Wang, Yonghui Su, Baimeng Zhang, Xingwei Liu. Evaluation of single-incision laparoscopic totally extra-peritoneal hernia repair by self-made path in adults with inguinal hernia[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2022, 16(06): 677-681.

目的

利用无菌手套及切口保护器自制单孔腹腔镜通道，进行成人腹股沟疝腹腔镜手术，并与常规三孔通道在应用价值、安全性及并发症等方面进行比较评估。

方法

纳入2017年7月至2019年3月中山大学附属第五医院胃肠外科行单侧或双侧完全腹膜外腹股沟疝修补术（TEP）的160例腹股沟疝患者，分为自制单孔组（SIL-TEP）及三孔组（MP-TEP），各80例，比较2组手术时间、并发症和疼痛视觉模拟量表评分（VAS）等。

结果

平均手术时间单孔组（86.06±33.69）min、三孔组（89.36±36.30）min，2组差异无统计学意义（P>0.05）。术后2 h VAS评分单孔组（1.89±0.84）分明显低于三孔组（2.36±1.25）分,差异有统计学意义（P=0.005）；但术后24 h VAS评分[（1.55±0.50）分vs（1.63±0.48）分]，差异无统计学意义（P>0.05）。术后并发症发生率单孔组23.8%、三孔组26.3%，差异无统计学意义（P>0.05）。随访6个月，单孔组无复发病例，三孔组2例疝复发。

结论

单孔腹腔镜TEP较三孔腹腔镜TEP的切口数量减少，术后即刻疼痛感减轻，未发生严重并发症，手术时间未明显延长。

关键词: 疝，腹股沟, 腹腔镜, 疝修补术, 单孔
Objective

Using sterile gloves and incision protector, a single-hole laparoscopic path was developed to perform adult laparoscopic inguinal hernia repair. To assess the safety, efficacy and complications of self-made path single-incision laparoscopic totally extra-peritoneal hernia repair (SIL-TEP) compared with conventional multiple-port laparoscopic totally extra-peritoneal hernia repair (MP-TEP).

Methods

We enrolled 160 patients with inguinal hernia who underwent unilateral or bilateral TEP in the Department of Gastrointestinal Surgery of the Fifth Affiliated Hospital of Sun Yat Sen University from July 2017 to March 2019. Eighty patients underwent self-made path SIL-TEP, and 80 patients underwent MP-TEP. The operation time, complications and visual analogue pain scale (VAS) were compared between the two groups.

Results

There were no significant differences in mean operation time between the SIL-TEP and MP-TEP groups [(86.06±33.69) min vs (89.36±36.30) min, P>0.05]. The postoperative 2 h VAS scores of SIL-TEP group was significantly lower than MP-TEP group [(1.89±0.84) vs (2.36±1.25), P=0.005], but postoperative 24 h VAS scores did not differ significantly between the two groups [(1.55±0.50) vs (1.63±0.48), P>0.05). The incidence of postoperative complications was similar between the SIL-TEP (23.8%) and MP-TEP groups (26.3%), P>0.05. We saw no recurrence at least 6-month follow-up in SIL-TEP group, and 2 recurrence in MP-TEP group.

Conclusion

Compared with MP-TEP, SIL-TEP had fewer incisions, milder postoperative pain scores, no severe complications, and similar operation time.

Key words: Hernia, inguinal, Laparoscopes, Herniorrhaphy, Single-incision
图1 自制单孔通道的材料及建立方法注：1A准备好所需耗材；1B将一次性戳卡置入手套指端并绑好；1C于脐部切开一小口，约2.5 cm；1D置入后血管钳固定手套，完成通道建立
图2 单孔腹腔镜下直疝假疝囊固定注：2A左侧腹股沟直疝假疝囊可见；2B固定后可见原假疝囊处缺损消失
图3 单孔腹腔镜下补片放置注：3A右侧腹股沟区植入补片；3B补片铺开后覆盖肌耻骨孔
表1 2组患者一般资料及临床特征比较[例(%)]
组别 例数 性别 年龄(岁,±s) 病程(月,±s) 体质量指数(kg/m2,±s) 既往病史
男 女 慢性咳嗽 便秘 前列腺肥大 腹水 糖尿病 高血压 下腹部手术史
单孔组 80 77(96.3) 3(3.8) 50.8±13.5 39.18±9.87 23.46±3.04 5(6.3) 2(2.5) 6(7.5) 2(2.5) 4(5.0) 19(23.8) 15(18.8)
三孔组 80 77(96.3) 3(3.8) 53.5±15.6 28.08±7.76 22.82±3.16 6(7.5) 6(7.5) 6(7.5) 1(1.3) 3(3.8) 10(12.5) 15(18.8)
t/χ2值   0.000 0.000 -1.184 0.880 1.417 0.098 2.092 0.000 0.338 0.148 3.411 0.000
P值   1.000 1.000 0.238 0.380 0.159 0.755 0.148 1.000 0.561 0.700 0.065 1.000
组别 例数 疝分类 疝部位
斜疝 直疝 复合疝 阴囊疝 复发疝 右侧 左侧 双侧
单孔组 80 53(66.3) 8(10.0) 19(23.8) 33(41.3) 5(6.3) 41(51.3) 20(25.0) 19(23.8)
三孔组 80 58(72.5) 7(8.8) 15(18.8) 28(35.0) 4(5.0) 43(53.8) 26(32.5) 11(13.8)
t/χ2值   0.735 0.074 0.598 0.662 0.118 0.100 1.098 2.626
P值   0.391 0.786 0.440 0.416 0.732 0.752 0.295 0.105
表2 2组患者手术相关指标比较（±s）
组别 例数 手术出血量(ml) 手术时间(min) 中转手术[例(%)] 术后视觉模拟量表评分 术后住院时间(d) 总住院时间(d)
2 h 24 h
单孔组 80 10.81±6.52 86.06±33.69 2(2.5) 1.89±0.84 1.55±0.50 1.48±0.69 3.53±1.64
三孔组 80 10.05±6.08 89.36±36.30 5(6.3) 2.36±1.25 1.63±0.48 2.96±1.71 5.51±2.39
t/χ2值   0.764 -0.439 1.336 -2.827 -0.960 -7.212 -6.114
P值   0.446 0.552 0.248 0.005 0.338 <0.01 <0.01
表3 2组患者疝复发及并发症比较[例（%）]
组别 例数 复发 血肿 阴囊水肿 血清肿 切口液化 肠梗阻 慢性疼痛 补片感染 总并发症
单孔组 80 0 1(1.3) 4(5.0) 13(16.3) 1(1.3) 0 0 0 19(23.8)
三孔组 80 2(2.5) 6(7.5) 4(5.0) 9(11.3) 1(1.3) 1(1.3) 0 0 21(26.3)
χ2值   2.013 1.943 0.000 0.915 0.000 1.000 0.000 0.000 0.133
P值   0.156 0.054 1.000 0.362 1.000 0.320 1.000 1.000 0.715
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