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 (03) : 282 -290. doi: 10.3877/cma.j.issn.1674-392X.2024.03.010

论著

腹腔镜完全腹膜外斜疝修补手术关闭内环口对血清肿发生率的影响
张庆峰1, 邓旭明2, 段巧斌2, 姚干2,(), 张策3,()   
  1. 1. 510515 广州,南方医科大学南方医院普外科;528000 广东,佛山市第一人民医院疝和腹壁外科
    2. 528000 广东,佛山市第一人民医院疝和腹壁外科
    3. 510515 广州,南方医科大学南方医院普外科
  • 收稿日期:2024-02-21 出版日期:2024-06-18
  • 通信作者: 姚干, 张策
  • 基金资助:
    国家自然科学基金(81270565)

The impact of internal ring closure on seroma incidence in laparoscopic totally extraperitoneal inguinal hernia repair

Qingfeng Zhang1, Xuming Deng2, Qiaobin Duan2, Gan Yao2,(), Ce Zhang3,()   

  1. 1. Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China; Department of Hernia and Abdominal Wall Surgery, Foshan First People's Hospital, Foshan 528000, Guangdong Province, China
    2. Department of Hernia and Abdominal Wall Surgery, Foshan First People's Hospital, Foshan 528000, Guangdong Province, China
    3. Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
  • Received:2024-02-21 Published:2024-06-18
  • Corresponding author: Gan Yao, Ce Zhang
引用本文:

张庆峰, 邓旭明, 段巧斌, 姚干, 张策. 腹腔镜完全腹膜外斜疝修补手术关闭内环口对血清肿发生率的影响[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(03): 282-290.

Qingfeng Zhang, Xuming Deng, Qiaobin Duan, Gan Yao, Ce Zhang. The impact of internal ring closure on seroma incidence in laparoscopic totally extraperitoneal inguinal hernia repair[J/OL]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2024, 18(03): 282-290.

目的

确认腹腔镜完全腹膜外斜疝修补手术(TEP)中进行横断疝囊后关闭内环口在降低术后血清肿发生率上是否优于横断疝囊后远端旷置以及完整剥离斜疝疝囊。

方法

于2021年8月15至2023年9月15日在佛山市第一人民医院疝和腹壁外科募集受试者,按1∶1∶2随机分派至关闭组、旷置组和剥离组,分别施行对应术式,收集住院和随访记录、手术视频、检查报告单等资料,分析比较3组之间术后血清肿发生率、手术时间、术中出血量、术中出血事件、术后疼痛评分及其他术后并发症等的差异。

结果

454例入组成功,排除术中组间转换及失访病例后共389例纳入统计分析,其中关闭组84例、旷置组82例、剥离组223例,术后血清肿发生率总体为22.62%(88/389),关闭组26.2%(22/84)、旷置组29.3%(24/82)、剥离组18.8%(42/223),3组间差异无统计学意义(P=0.105);将影响血清肿发生率的相关因素(疝囊最大径线、术中出血事件和术中出血量)拟合疝囊处理方式进行分层卡方分析显示,当疝囊最大径线≥10 cm时,剥离组的血清肿发生率高于关闭组(83.3%比31.1%),差异有统计学意义(P=0.001),当手术出血量>5 ml时,旷置组血清肿发生率高于关闭组(90.0%比33.3%),差异有统计学意义(P=0.036)。

结论

本研究中三种疝囊处理方式有各自的临床适用性,其术后血清肿发生率在总体受试者中无明显差异,完整剥离适用于疝囊最大径线<10 cm的病例且效果更优,而在疝囊最大径线≥10 cm、术中出血量>5 ml时选用关闭内环口方式处理疝囊,在降低血清肿发生率上优于其他两种方式。

Objective

To determine whether internal ring closure following transverse sac transection during laparoscopic totally extraperitoneal (TEP) inguinal hernia repair is superior in reducing postoperative seroma incidence compared to transverse sac transection with distal sac abandonment or complete sac dissection.

Methods

From August 15, 2021, to September 15, 2023, participants were recruited from the Hernia and Abdominal Wall Surgery Department at Foshan First People's Hospital. Participants were randomly assigned in a 1:1:2 ratio to the closure group, abandonment group, or dissection group, respectively. Relevant data, including hospitalization records, follow-up records, surgical videos, and examination reports, were collected to analyze and compare the incidence of postoperative seroma, operation time, intraoperative blood loss, intraoperative bleeding events, postoperative pain scores, and other postoperative complications among the three groups.

Results

A total of 454 participants were successfully enrolled. After excluding cases that involved intraoperative group crossover or loss to follow-up, 389 participants were included in the statistical analysis: 84 in the closure group, 82 in the abandonment group, and 223 in the dissection group. The overall incidence of postoperative seroma was 22.62% (88/389), with 26.2% (22/84) in the closure group, 29.3% (24/82) in the abandonment group, and 18.8% (42/223) in the dissection group. No statistically significant difference was found among the three groups (P=0.105). A stratified chi-square analysis of factors affecting seroma incidence (maximum sac diameter, intraoperative bleeding events, and intraoperative blood loss) showed that when the maximum sac diameter was ≥10 cm, the incidence of seroma in the dissection group was significantly higher than in the closure group (83.3% vs 31.1%, P=0.001). When intraoperative blood loss was >5 ml, the incidence of seroma in the abandonment group was significantly higher than in the closure group (90.0% vs 33.3%, P=0.036).

Conclusion

Each of the three sac management techniques has its own clinical applicability. There is no significant difference in the overall incidence of postoperative seroma among the techniques. Complete sac dissection is more effective for cases with a maximum sac diameter <10 cm, while internal ring closure is superior for reducing seroma incidence in cases with a maximum sac diameter ≥10 cm or intraoperative blood loss >5 ml.

图1 双重关闭斜疝疝囊(右侧)操作示意图注:1A分离斜疝疝囊与精索成分(箭头所示);1B置入2-0可吸收线结扎疝囊;1C体外打结后推结关闭远端疝囊;1D同法结扎关闭近端疝囊;1E两结扎点中间横断疝囊;1F箭头所示内环口呈关闭状态。
图2 受试者流程图
表1 研究对象的基线特征
表2 不同术式的手术情况和术后血清肿发生率、其他并发症的比较分析
图3 影响血清肿发生率的多因素分析
表3 影响血清肿发生率的单因素分析
表4 相关因素分层后不同术式血清肿发生率
[1]
Gutlic N, Gutlic A, Petersson U, et al. Randomized clinical trial comparing total extraperitoneal with Lichtenstein inguinal hernia repair(TEPLICH trial)[J]. Br J Surg, 2019, 106(7): 845-855.
[2]
Cihan A, Ozdemir H, Ucan BH, et al. Fade or fate. Seroma in laparoscopic inguinal hernia repair[J]. Surg Endosc, 2006, 20(2): 325-328.
[3]
董泾青. 膜解剖理念在腹腔镜完全腹膜外疝修补术中的应用[J/OL]. 中华疝和腹壁外科杂志(电子版), 2020, 14(5): 472-475.
[4]
Fan JKM, Liu JW, Kim HJ. Seroma after TEP, preventable or not? Author’s reply[J]. Hernia, 2021, 25: 243-244.
[5]
Li J. Seroma after TEP, preventable or not?[J]. Hernia, 2021, 25: 239-241.
[6]
The Hernia Surge Group. International guidelines for groin hernia management[J]. Hernia, 2018, 22: 1-165.
[7]
唐健雄,郑民华,陈杰,等.腹腔镜腹股沟疝手术操作指南(2017版)[J]. 中国实用外科杂志, 2017, 37(11): 1238-1242.
[8]
Choi YY, Kim Z, Hur KY. Transection of the hernia sac during laparoscopic totally extraperitoneal inguinal hernioplasty: is it safe and feasible?[J]. J Laparoendosc Adv Surg Tech, 2011, 21(2): 149-152.
[9]
Sürgit Ö, Çavuşoğlu NT, Kılıç , et al. Use of fibrin glue in preventing pseudorecurrence after laparoscopic total extraperitoneal repair of large indirect inguinal hernia[J]. Ann Surg Treat Res, 2016, 91(3): 127-132.
[10]
Hasanein A, Rabea M, Fathi M, et al. Laparoscopic purse-string suture sac closure is appropriate procedure for children with unilateral indirect inguinal hernia: comparative study versus laparoscopic sac excision and closure procedure[J]. Egypt J Surg, 2017, 36: 394-400.
[11]
Li J, Ji Z, Shao X. Prevention of seroma formation after laparoscopic inguinoscrotal indirect hernia repair by a new surgical technique: a preliminary report[J]. Int J Abdom Wall Hernia Surg, 2018, 1: 55-9.
[12]
Li B, Shi S, Qin C, et al. Internal ring defect closure technique in laparoscopic mesh hernioplasty for indirect inguinal hernia[J]. Front Surg, 2022, 9: 794420.
[13]
吴志强, 姚干, 梁健升, 等. 腹股沟疝腹腔镜腹腔内网片植入术后并发症的分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2012, 6(2): 60-62.
[14]
李绍春, 李绍杰, 马慧, 等. 腹股沟疝修补术后血清肿的研究进展[J]. 中国普通外科杂志, 2022, 31(10): 1389-1394.
[15]
Chai SW, Chiang PH, Chien CY, et al. Sac transection versus sac reduction during laparoscopic herniorrhaphy: a systematic review and meta-analysis[J]. Asian J Surg, 2022, 45(4): 981-986.
[16]
Li J., Gong W., Liu Q.. Intraoperative adjunctive techniques to reduce seroma formation in laparoscopic inguinal hernioplasty: a systematic review[J]. Hernia, 2019, 23(4): 723-731.
[17]
Li J, Bao P, Shao X, et al. The management of indirect inguinal hernia sac in laparoscopic inguinal hernia repair: a systemic review of literature[J]. Surg Laparosc Endosc Percutan Tech, 2021, 31(5): 645-653.
[18]
Chaouch MA, Hussain MI, Gouader A, et al. A systematic review and meta-analysis of hernia sac management in laparoscopic groin hernia mesh repair: reduction or transection?[J]. BMC Surg, 2023, 23(1): 249.
[19]
Li W, Li Y, Ding L, et al. A randomized study on laparoscopic total extraperitoneal inguinal hernia repair with hernia sac transection vs complete sac reduction[J]. Surg Endosc, 2020, 34: 1882-1886.
[20]
Ruze R, Yan Z, Wu Q, et al. Correlation between laparoscopic transection of an indirect inguinal hernial sac and postoperative seroma formation: a prospective randomized controlled study[J]. Surg Endosc, 2019, 33(4): 1147-1154.
[21]
Amr WM, Abdel Bari A, Mihedi A, et al. The management of indirect inguinal hernia sac in laparoscopic transabdominal pre-peritoneal procedure hernia repair[J]. Egypt J Hosp Med, 2023, 91(1): 5207-5211.
[22]
Liu L, Hu J, Zhang TH, et al. Influence of the hernia sac treatment method on the occurrence of seroma after laparoscopic transabdominal preperitoneal hernia repair[J]. Asian J Surg, 2023, 46(2): 718-722.
[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] 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.
[11] 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.
[12] 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.
[13] 郭兵, 王万里, 何凯, 黄汉生. 腹腔镜下肝门部胆管癌根治术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(01): 143-143.
[14] 李凯, 陈淋, 苏怀东, 向涵, 张伟. 超微创器械在改良单孔腹腔镜巨大肝囊肿开窗引流及胆囊切除中的应用[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(01): 144-144.
[15] 魏丽霞, 张安澜, 周宝勇, 李明. 腹腔镜下Ⅲb型肝门部胆管癌根治术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(01): 145-145.
阅读次数
全文


摘要