直疝假疝囊四针固定法在单孔腹腔镜腹股沟疝中的应用

doi:10.3877/cma.j.issn.1674-392X.2023.04.012

中华疝和腹壁外科杂志(电子版) ›› 2023, Vol. 17 ›› Issue (04) : 423 -426. doi: 10.3877/cma.j.issn.1674-392X.2023.04.012

论著

直疝假疝囊四针固定法在单孔腹腔镜腹股沟疝中的应用

张一忠, 叶乐斌, 帅勇锋, 陈军杰, 唐健松, 俞振良, 吴卫东^†(

)

315020　浙江，宁波大学医学院附属医院疝与腹壁外科
315899　浙江，宁波市北仑区中医院普通外科
315711　浙江，宁波市北仑区第三人民医院普外科
315899　浙江，宁波大学医学院附属医院北仑分院普通外科
200080　上海交通大学附属第一人民医院普外中心胃肠外科

收稿日期:2022-11-07 出版日期:2023-08-18
通信作者: 吴卫东
基金资助:
中华医学会医学教育分会和中国高等教育学会医学教育专业委员会2020年医学教育研究立项课题(2020BN05099)

Application of four-needle stitching for direct hernia pseudosac in single-incision laparoscopic inguinal hernia repair

Yizhong Zhang, Lebin Ye, Yongfeng Shuai, Junjie Chen, Jiansong Tang, Zhenliang Yu, Weidong Wu^†()

Department of Hernia and Abdominal Surgery, Affiliated Hospital of Medical School of Ningbo University, Ningbo 315020, Zhejiang Province, China
Department of General Surgery, Beilun District Hospital of China Medicine, Ningbo 315899, Zhejiang Province, China
Department of General Surgery, Beilun District Third People's Hospital, Ningbo 315711, Zhejiang Province, China
Department of General Surgery, Beilun Branch of Affiliated Hospital of Medical School of Ningbo University, Ningbo 315899, Zhejiang Province, China
Department of Gastrointestinal Surgery, Shanghai General Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China

Received:2022-11-07 Published:2023-08-18
Corresponding author: Weidong Wu

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引用本文：

张一忠, 叶乐斌, 帅勇锋, 陈军杰, 唐健松, 俞振良, 吴卫东. 直疝假疝囊四针固定法在单孔腹腔镜腹股沟疝中的应用[J/OL]. 中华疝和腹壁外科杂志(电子版), 2023, 17(04): 423-426.

Yizhong Zhang, Lebin Ye, Yongfeng Shuai, Junjie Chen, Jiansong Tang, Zhenliang Yu, Weidong Wu. Application of four-needle stitching for direct hernia pseudosac in single-incision laparoscopic inguinal hernia repair[J/OL]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2023, 17(04): 423-426.

目的

评估单孔腹腔镜下全腹膜外腹股沟疝修补术（SIL-TEP）中应用"四针固定法"处理直疝假疝囊的效果。

方法

2020年1月至2022年7月，在宁波大学医学院附属医疗集团内行SIL-TEP的腹股沟直疝患者，共45例52侧，应用"四针固定法"处理假疝囊。收集并分析患者术前基本情况，术中单侧处理假疝囊时间、手术时间、出血量及术中并发症情况，术后疼痛和随访情况。

结果

45例计52侧假疝囊应用"四针固定法"手术均获得成功。处理一侧假疝囊时间4~11 min，平均（5.85±1.27）min。术中无血管、神经损伤。术后24、48 h视觉模拟评分分别为2（1）分、0（0）分。患者住院时间（4.78±1.81）d。术后随访时间4~34个月，平均（16.98±10.14）个月，随访期间发现无症状血清肿1例（2.22%），术后近期局部疼痛1例，1个月后自行缓解，无补片感染、复发及慢性疼痛。

结论

单孔腹腔镜下"四针固定法"处理直疝假疝囊简便、安全、可靠。

关键词: 疝，腹股沟, 腹腔镜, 疝修补术, 直疝, 疝囊, 血清肿

Objective

To evaluate the clinical effect of four-needle stitching in single-incision laparoscopic totally extra-peritoneal (SIL-TEP) inguinal hernia repair for direct hernia pseudo-sac management.

Methods

From January 2020 to July 2022, 45 cases with 52 sides direct inguinal hernia's pseudo-sac were managed with a four-needle stitching technique during SIL-TEP in the Affiliated Hospital Group of Ningbo University Medical College. Clinical data were collected and analyzed, including preoperative condition, operative time, the time of unilateral management of hernia pseudosac, blood loss and complications, postoperative pain, and follow-up.

Results

A total of 45 cases with 52 sides pseudo-sacs were successfully managed with four-needle stitching technique. The mean time of unilateral pseudo-sac fixation was 5.85±1.27 (4~11) min. There was no vascular or nerve damage. The mean visual analog scores (VAS) of pains was 2(1) at 24 hours and 0(0) at 48 hours after surgery. The mean hospital stay after surgery was (4.78±1.81) d. The mean follow-up time was 16.98±10.14 (4~34) months. During follow-up, 1 case (2.22%) of seroma without clinical symptoms was found. Also, 1 case complained short-term local pain after surgery, which disappeared spontaneously after 1 month. No mesh infection, hernia recurrence and chronic pain was found.

Conclusion

The four-needle stitching under SIL-TEP for treating direct hernia pseudo-sac is simple, safe and feasible.

Key words: Hernia, inguinal, Laparoscope, Herniorrhaphy, Direct hernia, Hernial sac, Seroma

图12 术后（站立位）

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Application of four-needle stitching for direct hernia pseudosac in single-incision laparoscopic inguinal hernia repair

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Application of four-needle stitching for direct hernia pseudosac in single-incision laparoscopic inguinal hernia repair