切换至 "中华医学电子期刊资源库"

中华疝和腹壁外科杂志(电子版) ›› 2024, Vol. 18 ›› Issue (01) : 45 -49. doi: 10.3877/cma.j.issn.1674-392X.2024.01.009

疝外科日间手术专栏

腹腔镜全腹膜外腹股沟疝修补术日间手术模式临床应用研究
钟春林1, 罗丹1, 于颖娟1, 杨可1, 周燕1, 张梅1, 刘文1,()   
  1. 1. 621000 四川省绵阳市中心医院普外科
  • 收稿日期:2023-12-10 出版日期:2024-02-18
  • 通信作者: 刘文

Study on the clinical application of laparoscopic total extraperitoneal inguinal hernia repair day surgery mode

Chunlin Zhong1, Dan Luo1, Yingjuan Yu1, Ke Yang1, Yan Zhou1, Mei Zhang1, Wen Liu1,()   

  1. 1. Department of General Surgery, Mianyang Central Hospital, Sichuan Province, Mianyang 621000, Sichuan, China
  • Received:2023-12-10 Published:2024-02-18
  • Corresponding author: Wen Liu
引用本文:

钟春林, 罗丹, 于颖娟, 杨可, 周燕, 张梅, 刘文. 腹腔镜全腹膜外腹股沟疝修补术日间手术模式临床应用研究[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(01): 45-49.

Chunlin Zhong, Dan Luo, Yingjuan Yu, Ke Yang, Yan Zhou, Mei Zhang, Wen Liu. Study on the clinical application of laparoscopic total extraperitoneal inguinal hernia repair day surgery mode[J/OL]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2024, 18(01): 45-49.

目的

全腹膜外腹腔镜腹股沟疝修补术(TEP)是目前临床治疗腹股沟疝的主要手术方式之一,本文旨在探讨TEP手术在日间手术模式的安全性及有效性。

方法

回顾性分析2022年6月至2023年6月,绵阳市中心医院行日间腹股沟疝手术患者的临床资料,依据手术方式将患者分为开放组(开放腹膜前修补手术236例)、TEP组(124例)。分析对比2组患者手术相关指标(手术时间、术中出血量、术后下床活动时间、切口愈合时间、住院费用)、并发症(尿潴留发生率、阴囊积液发生率、异物感、慢性疼痛、切口感染、术区积液及总并发症发生率)、就医满意度及术后6个月复发情况。

结果

所有患者均顺利完成手术,TEP组无中转。单侧腹股沟疝手术时间开放组优于TEP组,双侧腹股沟疝手术时间,2组比较差异无统计学意义。2组患者术中出血量比较差异无统计学意义(P>0.05),TEP组下床活动时间、切口愈合时间明显优于开放组[(4.5±2.4)h vs(6.9±1.5)h;(8.5±1.7)d vs(11.2±2.3)d],住院费用高于开放组,差异均有统计学意义(P<0.05)。2组患者术后尿潴留、阴囊积液、术区积液及总并发症发生率比较,差异无统计学意义(P>0.05);开放组术区异物感及切口感染发生率高于TEP组,差异有统计学意义(P<0.05)。术后3个月TEP组患者整体满意度明显优于开放组(95.1% vs 90.2%),差异有统计学意义(P<0.05)。2组患者术后随访6个月,除开放组2例失访外,经超声检查均无复发病例。

结论

TEP在日间手术模式下安全有效,可在熟练掌握后应用。

Objective

Total extraperitoneal laparoscopic inguinal hernia repair (TEP) is one of the main surgical methods for treatment of inguinal hernia. The purpose of this paper is to explore the safety and effectiveness of TEP surgery in the day surgery mode.

Methods

The clinical data of patients undergoing inguinal hernia day surgery in Mianyang Central Hospital from June 2022 to June 2023 were retrospectively analyzed. They were divided into the open group (236 cases of open preperitoneal repair) and the TEP group (124 cases) by surgical methods. The operation indexes (operation time, intraoperative blood loss, postoperative ambulation time, the time of incision healing, hospitalization cost), complications (urinary retention, scrotal effusion, foreign body sensation, chronic pain, infection of incision, operated region effusion, and total complication rate), satisfaction, and recurrence 6 months after surgery were analyzed and compared between the two groups.

Results

All patients successfully completed the operation, and there was no conversion in the TEP group. The operation time of unilateral inguinal hernia in the open group was shorter than in the TEP group. There was no statistically significant difference in the surgical time for bilateral inguinal hernia between the two groups of patients. There was no significant difference in intraoperative blood loss between the two groups. The time of getting out of bed and the time of incision healing were significantly shorter in the TEP group than those of the open group [(4.5±2.4) hours vs (6.9±1.5) hours; (8.5±1.7) days vs (11.2±2.3) days], and the difference was statistically significant (P<0.05). The hospitalization cost of the TEP group was higher than that of the open group (P<0.05). There was no significant difference in incidence of postoperative urinary retention, scrotal effusion, chronic pain, operated region effusion, and total complication rate between the two groups of patients (P>0.05). The incidence of foreign body sensation and incision infection in the open group was higher than in the TEP group (P<0.05). The overall satisfaction of TEP group was significantly better than that of open group (95.1% vs 90.2%) three months after operation, and the difference was statistically significant (P<0.05). Both groups were followed up for 6 months after surgery, except 2 cases in the open group, and no recurrence cases were detected by ultrasound.

Conclusion

TEP is safe and effective in day surgery mode, and can be applied after proficiency.

表1 2组患者的一般资料比较
表2 2组患者手术相关指标比较(±s
表3 2组患者并发症发生情况比较[例(%)]
表4 2组患者满意度比较[例(%)]
[1]
Pónusz R, Endrei D, Kovács D, et al. Analysis of the utilization of one-day surgery in Hungary[J]. Orv Hetil, 2019, 160(17): 670-678.
[2]
Zhong Y, He M, Liu Z, et al. Efficacy of laparoscopic inguinal hernia in day surgery mode and inpatient surgery mode in China: A meta-analysis[J]. Medicine(Baltimore), 2023, 102(8): e32998.
[3]
Steger U, Bisping M, Urban J, et al. Day surgery for endoscopic inguinal hernia repair[J]. Zentralbl Chir, 2019, 144(1): 26-31.
[4]
中国医师协会外科医师分会疝和腹壁外科学组. 腹股沟疝日间手术规范化流程专家共识[J]. 中华消化外科杂志, 2020, 7(19): 714-719.
[5]
中华医学会麻醉学分会. 日间手术麻醉专家共识[J].临床麻醉学杂志, 2016, 32(10): 1017-1022.
[6]
冯伟, 汪启乐, 王盛. 日间手术延期恢复模式下完全腹膜外与经腹腹膜前疝修补术在老年腹股沟疝中的应用[J]. 腹腔镜外科杂志, 2021, 26(6): 426-429.
[7]
Drahman A, Ngee-Soon SL, Crawford M. Prophylactic alpha-blockade for prevention of post-operative urinary retention after inguinal hernia repair: a systematic review and meta-analysis[J]. Hernia, 2023, 27(6): 1351-1361.
[8]
Guillaumes S, Hidalgo NJ, Bachero I, et al. Outpatient inguinal hernia repair in Spain: a population-based study of 1, 163, 039 patients-clinical and socioeconomic factors associated with the choice of day surgery[J]. Updates Surg, 2023, 75(1): 65-75.
[9]
陈杰, 那冬鸣, 申英末, 等. 局部神经阻滞麻醉在腹股沟无张力疝修补术中的应用[J]. 中华普通外科杂志, 2005, 20(2): 107-108.
[10]
Chen LS, Chen WC, Kang YN, et al. Effects of transabdominal preperitoneal and totally extraperitoneal inguinal hernia repair: an update systematic review and meta-analysis of randomized controlled trials[J]. Surg Endosc, 2019, 33(2): 418-428.
[11]
Ziga M, Burla L, Imhof A, et al. Inguinal hernia treatment in Switzerland: inpatient vs. outpatient setting-HerStAmb Study (prospective observational two-centre comparative study)[J]. Langenbecks Arch Surg, 2023, 408(1): 14.
[12]
Pararas N, Pikouli A, Bounnah M, et al. Laparoscopic Inguinal Hernia Repair in the Obese Patient Population: A Single-Center Five-Year Experience[J]. Cureus, 2023, 15(11): e48265.
[13]
Griffin KJ, Harris S, Fang TY, et al. Incidence of contralateral occult inguinal hernia found at the time of laparoseopie transabdominal preperitoneal(TAPP) repair[J].Hemia, 2010, 14(4): 345-349.
[14]
Doudakmanis C, Kolla C, Bouliaris K, et al. Laparoscopic bilateral inguinal hernia repair: Should it be the preferred technique?[J]. World J Methodol, 2022, 12(4): 193-199.
[15]
Hidalgo NJ, Guillaumes S, Bachero I, et al. Trends and predictors of laparoscopic bilateral inguinal hernia repair in Spain: a population-based study[J]. Surg Endosc, 2023, 37(6): 4784-4794.
[16]
Lelpo 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: 725-730.
[17]
Lelpo B, Nuñez J, Ferri V, et al. Laparoscopic inguinal hernia repair: cost-effectiveness analysis of trend modifications of the technique[J]. Updates Surg, 2021, 73(5): 1945-1953.
[18]
Liu J, Zhang H, Qiao X, et al. The feasibility and safety of laparoscopic inguinal hernia repair as a 24-h day surgery for patients aged 80 years and older: a retrospective cohort study[J]. Hernia, 2023, 27(6): 1533-1541.
[19]
Chung Y, Choi JW, Kim HC, et al. Feasibility of totally extraperitoneal(TEP) laparoscopic hernia repair in elderly patients[J]. Hernia, 2019, 23(2): 299-303.
[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] 任佳, 马胜辉, 王馨, 石秀霞, 蔡淑云. 腹腔镜全胃切除、间置空肠代胃术的临床观察[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 31-34.
[10] 赵丽霞, 王春霞, 陈一锋, 胡东平, 张维胜, 王涛, 张洪来. 内脏型肥胖对腹腔镜直肠癌根治术后早期并发症的影响[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 35-39.
[11] 李博, 贾蓬勃, 李栋, 李小庆. ERCP与LCBDE治疗胆总管结石继发急性重症胆管炎的效果[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 60-63.
[12] 韩戟, 杨力, 陈玉. 腹部形态CT参数与完全腹腔镜全胃切除术术中失血量的关系研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 88-91.
[13] 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.
[14] 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.
[15] 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.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?