耻脐入路单孔腹腔镜后鞘后技术在脐疝修补术中的应用

doi:10.3877/cma.j.issn.1674-392X.2024.02.011

中华疝和腹壁外科杂志(电子版) ›› 2024, Vol. 18 ›› Issue (02) : 184 -188. doi: 10.3877/cma.j.issn.1674-392X.2024.02.011

论著

耻脐入路单孔腹腔镜后鞘后技术在脐疝修补术中的应用

陈志升¹, 司仙科¹^,^†(

), 吴卫东², 李森¹, 杨佳华¹, 李炜¹, 郑侃¹, 于昆¹, 罗晓睿¹, 葛卫红³

^1. 200062　上海中医药大学附属普陀医院微创外科
^2. 200080　上海交通大学医学院附属第一人民医院胃肠外科
^3. 215300　江苏省昆山市第五人民医院普外科

收稿日期:2023-11-28 出版日期:2024-04-18
通信作者: 司仙科
基金资助:
上海中医药大学附属普陀医院百人计划(领航计划2022-RCLH-03)

Application of the supraumbilical single-port laparoscopic preperitoneal technique in umbilical hernia repair

Zhisheng Chen¹, Xianke Si¹^,^†(), Weidong Wu², Sen Li¹, Jiahua Yang¹, Wei Li¹, Kan Zheng¹, Kun Yu¹, Xiaorui Luo¹, Weihong Ge³

^1. Department of Minimally Invasive Surgery, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200062, China
^2. Department of Gastrointestinal Surgery, Shanghai General Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200080, China
^3. Department of General Surgery, The Fifth People's Hospital of Kunshan City, Suzhou 215300, Jiangsu Province, China

Received:2023-11-28 Published:2024-04-18
Corresponding author: Xianke Si

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陈志升, 司仙科, 吴卫东, 李森, 杨佳华, 李炜, 郑侃, 于昆, 罗晓睿, 葛卫红. 耻脐入路单孔腹腔镜后鞘后技术在脐疝修补术中的应用[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(02): 184-188.

Zhisheng Chen, Xianke Si, Weidong Wu, Sen Li, Jiahua Yang, Wei Li, Kan Zheng, Kun Yu, Xiaorui Luo, Weihong Ge. Application of the supraumbilical single-port laparoscopic preperitoneal technique in umbilical hernia repair[J/OL]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2024, 18(02): 184-188.

目的

探讨耻脐入路单孔腹腔镜后鞘后修补术治疗脐疝的临床应用价值。

方法

回顾性研究2021年6月至2023年8月，上海中医药大学附属普陀医院微创外科收治的18例实施耻脐入路单孔腹腔镜后鞘后疝修补术的脐疝患者，根据临床病例资料、手术操作的技术细节及术后随访情况，分析该术式的临床效果及获益。

结果

18例患者均顺利完成手术，无中转开放手术，平均手术时间（106.67±28.49）min，术后6～8 h下床活动，术后8、24 h视觉模拟评分分别为2.94、2.50分，术后平均住院时间为（2.02±0.63）d；术后均无出血、肠梗阻、肠瘘、脐部坏死等严重并发症；随访时间为3～28个月，随访率100%，无复发。

结论

耻脐入路行单孔腹腔镜下后鞘后脐疝修补术安全可行，隐瘢痕效果好，术后疼痛轻，恢复快，可作为腹腔镜下脐疝修补的一种选择术式。

关键词: 脐疝, 耻脐入路, 腹腔镜，单孔, 后鞘后间隙, 疝修补术

Objective

To explore the clinical application value of the supraumbilical single-port laparoscopic preperitoneal repair technique in the treatment of umbilical hernias.

Methods

This retrospective study reviewed 18 patients who underwent umbilical hernia repair using the supraumbilical single-port laparoscopic preperitoneal technique at the Department of Minimally Invasive Surgery, Putuo Hospital, affiliated with Shanghai University of Traditional Chinese Medicine, from June 2021 to August 2023. The clinical outcomes and benefits were analyzed based on clinical data, technical details of the surgical procedure, and postoperative follow-up.

Results

All 18 patients successfully underwent surgery without conversion to open surgery. The average operation time was 106.67±28.49 minutes. Patients were encouraged to ambulate for 6 to 8 hours postoperatively. The visual analog scale scores at 8 and 24 hours postoperatively were 2.94 and 2.50, respectively. The average postoperative hospital stay was (2.02±0.63) days. There were no serious complications such as bleeding, intestinal obstruction, enterocutaneous fistula, or umbilical necrosis postoperatively. Follow-up periods ranged from 3 to 28 months, with a 100% follow-up rate and no recurrence observed.

Conclusion

The supraumbilical single-port laparoscopic preperitoneal umbilical hernia repair technique is safe and feasible, offering excellent cosmetic results with minimal scarring, less postoperative pain, and rapid recovery. It can be considered an alternative technique for laparoscopic umbilical hernia repair.

Key words: Umbilical hernia, Supraumbilical approach, Laparoscopy, Single-port, Preperitoneal space, Hernia repair

图9 术后瘢痕效果。

表1 实施耻脐入路单孔腹腔镜后鞘后修补术患者的术后随访资料[例（%）]

随访时间	例数	异物感	手术区域疼痛				活动受限	手术整体满意度					切口满意度
随访时间	例数	异物感	无痛	轻度疼痛	中度疼痛	重度疼痛	活动受限	非常满意	满意	一般	不满意	非常不满意	满意	一般	不满意
术后1周	18	3(16.67)	15(83.33)	2(11.11)	1(5.56)	0(0.00)	0(0.00)	16(88.89)	2(11.11)	0(0.00)	0(0.00)	0(0.00)	18(100.00)	0(0.00)	0(0.00)
术后1个月	18	1(5.56)	17(94.44)	1(5.56)	0(0.00)	0(0.00)	0(0.00)	17(94.44)	1(5.56)	0(0.00)	0(0.00)	0(0.00)	18(100.00)	0(0.00)	0(0.00)
术后3个月	18	0(0.00)	18(100.00)	0(0.00)	0(0.00)	0(0.00)	0(0.00)	18(100.00)	0(0.00)	0(0.00)	0(0.00)	0(0.00)	18(100.00)	0(0.00)	0(0.00)

表1 实施耻脐入路单孔腹腔镜后鞘后修补术患者的术后随访资料[例（%）]

随访时间	例数	异物感	手术区域疼痛				活动受限	手术整体满意度					切口满意度
随访时间	例数	异物感	无痛	轻度疼痛	中度疼痛	重度疼痛	活动受限	非常满意	满意	一般	不满意	非常不满意	满意	一般	不满意
术后1周	18	3(16.67)	15(83.33)	2(11.11)	1(5.56)	0(0.00)	0(0.00)	16(88.89)	2(11.11)	0(0.00)	0(0.00)	0(0.00)	18(100.00)	0(0.00)	0(0.00)
术后1个月	18	1(5.56)	17(94.44)	1(5.56)	0(0.00)	0(0.00)	0(0.00)	17(94.44)	1(5.56)	0(0.00)	0(0.00)	0(0.00)	18(100.00)	0(0.00)	0(0.00)
术后3个月	18	0(0.00)	18(100.00)	0(0.00)	0(0.00)	0(0.00)	0(0.00)	18(100.00)	0(0.00)	0(0.00)	0(0.00)	0(0.00)	18(100.00)	0(0.00)	0(0.00)

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