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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) ›› 2024, Vol. 18 ›› Issue (03) : 296 -301. doi: 10.3877/cma.j.issn.1674-392X.2024.03.012

论著

腹腔镜增强视野完全腹膜外疝修补术和腹腔镜腹膜内补片修补术在腹壁疝修补中的安全性及临床疗效
徐杨荣1,†(), 杨毅1, 王凤飞1, 潘姣1   
  1. 1. 414000　湖南省岳阳市人民医院疝和腹壁外科
  • 收稿日期:2023-06-13 出版日期:2024-06-18
  • 通信作者: 徐杨荣
  • 基金资助:
    湖南省自然科学基金(2019JJ8017)

Safety and clinical efficacy of laparoscopic enhanced view totally extraperitoneal hernia repair and laparoscopic intraperitoneal onlay mesh repair in abdominal wall hernia repair

Yangrong Xu1,†(), Yi Yang1, Fengfei Wang1, Jiao Pan1   

  1. 1. Hernia and Abdominal Wall Surgery, Hunan Province YueyangCity the People's Hospital, Yueyang 414000, Hunan Province, China
  • Received:2023-06-13 Published:2024-06-18
  • Corresponding author: Yangrong Xu
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徐杨荣, 杨毅, 王凤飞, 潘姣. 腹腔镜增强视野完全腹膜外疝修补术和腹腔镜腹膜内补片修补术在腹壁疝修补中的安全性及临床疗效[J]. 中华疝和腹壁外科杂志(电子版), 2024, 18(03): 296-301.

Yangrong Xu, Yi Yang, Fengfei Wang, Jiao Pan. Safety and clinical efficacy of laparoscopic enhanced view totally extraperitoneal hernia repair and laparoscopic intraperitoneal onlay mesh repair in abdominal wall hernia repair[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2024, 18(03): 296-301.

目的

探讨腹腔镜增强视野完全腹膜外疝修补术（e-TEP）和腹腔镜腹膜内补片修补术（IPOM）在腹壁疝治疗中的应用价值，并阐述手术操作流程及技术细节，分析其可行性和有效性及经济性。

方法

回顾性分析2018年1月至2021年12月湖南省岳阳市人民医院82例腹壁疝患者的临床资料，按照术式不同分为对照组（40例）和试验组（42例）。对照组给予IPOM防粘连修补术，试验组给予e-TEP（普通补片）腹壁疝修补术治疗，比较2组患者术中及术后相关临床指标，并发症发生情况，对术后生活的满意度及住院费用。

结果

2组患者一般资料之间差异无统计学意义（P>0.05）；试验组手术时间长于对照组，术中失血量多于对照组，差异均有统计学意义（P<0.05）。2组视觉模拟评分、术后住院时间、复发率比较，差异均无统计学意义（P>0.05）。试验组总并发症发生率（14.30%）高于对照组（5.00%），差异有统计学意义（P<0.05）；但2组患者的切口感染、切口血清肿、术后疼痛等单项术后并发症比较，差异均无统计学意义（P>0.05）。2组术后总满意率比较，差异无统计学意义（P>0.05）；但试验组住院费用（1.52±0.23）万元低于对照组（2.45±0.35）万元，差异有统计学意义（P<0.05）。

结论

IPOM与e-TEP均是治疗成人腹壁疝的有效方法，两者相比较而言，IPOM具有手术时间短、手术出血量少、术后总并发症发生率低的优势，e-TEP具有住院费用低的优势。

关键词: 腹壁疝, 腹腔镜, 疝修补术, 成人
Objective

To explore the application value of laparoscopic enhanced view totally extraperitoneal (e-TEP) hernia repair and laparoscopic intraperitoneal onlay mesh (IPOM) repair in the treatment of abdominal wall hernias, and to elucidate the surgical procedures and technical details, analyzing their feasibility, effectiveness, and cost-effectiveness.

Methods

A retrospective analysis was conducted on the clinical data of 82 patients with abdominal wall hernias treated at Yueyang People's Hospital of Hunan Province from January 2018 to December 2021. The patients were divided into two groups based on the surgical procedure: the control group (40 cases) received IPOM anti-adhesion repair, while the experimental group (42 cases) underwent e-TEP (using ordinary mesh) hernia repair. Intraoperative and postoperative clinical indicators, complication rates, postoperative satisfaction, and hospitalization costs were compared between the two groups.

Results

There were no statistically significant differences in the general data between the two groups (P>0.05). The experimental group had a longer operation time and greater intraoperative blood loss than the control group, with both differences being statistically significant (P<0.05). There were no significant differences between the two groups in terms of visual analog scale scores, postoperative hospital stay, or recurrence rates (P>0.05). The overall complication rate in the experimental group (14.30%) was higher than in the control group (5.00%), with a statistically significant difference (P<0.05). However, there were no significant differences between the two groups in terms of individual postoperative complications such as wound infection, wound seroma, or postoperative pain (P>0.05). The overall postoperative satisfaction rate did not differ significantly between the two groups (P>0.05), but the hospitalization costs in the experimental group (15 200±2 300 ) yuan were significantly lower than those in the control group (24 500±3 500) yuan, with a statistically significant difference (P<0.05).

Conclusion

Both IPOM and e-TEP are effective methods for treating adult abdominal wall hernias. Compared to e-TEP, IPOM has the advantages of shorter operation time, less intraoperative blood loss, and a lower overall postoperative complication rate. However, e-TEP has the advantage of lower hospitalization costs.

Key words: Abdominal wall hernia, Laparoscopy, Herniorrhaphy, Adult
图1 阑尾术后切口疝注：术者位于患者左侧，观察孔位于平脐腹直肌外侧缘，主操作孔位于观察孔外侧一拳处，副操作孔位于主操作孔下一拳处。
图2 分离腹直肌后方与腹直肌后鞘前方之间的间隙（疏松无血管区）
图3 分离范围为外侧到达半月线，内侧为中线，视野下方为弓状线，此处可见后鞘向腹横筋膜的转化，视野上方为腹直肌和腹壁下血管[11]
图4 分离疝囊（先分离疝囊左右两侧约6 cm）
图5 上腹部白线疝鞘卡布局
图6 分离上腹部肌后间隙（腹直肌后方，疝囊周围5 cm）
图7 用倒刺线缝合关闭疝囊（不留死腔）
表1 2组患者一般资料比较
组别 例数 性别[例(%)] 年龄(岁,±s) 腹壁疝类型[例(%)]
男性 女性 脐疝 白线疝 阑尾术后切口疝 剖宫产术后切口疝 腹直肌分离
试验组 42 19(45.24) 23(54.76) 54.50±2.55 11(26.19) 6(14.29) 13(30.95) 6(14.29) 6(14.29)
对照组 40 18(45.00) 22(55.00) 55.22±2.35 10(25.00) 5(12.50) 14(35.00) 5(12.50) 6(15.00)
χ2/t值   0.12 0.73 0.53
P值   0.750 0.480 0.650
表2 2组患者术中及术后临床指标比较
组别 例数 手术时间(min,±s) 术中出血量(ml,±s) 视觉模拟评分(分,±s) 住院时间(d,±s) 复发率[例(%)]
试验组 42 90.00±8.62 60.00±4.15 3.05±0.58 4.52±1.25 1(2.25)
对照组 40 60.00±10.52 50.00±5.21 2.85±0.83 4.12±1.05 0(0.00)
t/χ2值   20.32 19.32 2.41 1.32 2.42
P值   <0.001 <0.001 0.212 0.362 0.231
表3 2组患者术后并发症发生率比较[例（%）]
组别 例数 术后血清肿 术后疼痛 肠道损伤 切口感染 总发生率
试验组 42 2(4.76) 2(4.76) 1(1.22) 1(1.22) 6(14.3)
对照组 40 0(0.00) 1(1.22) 0(0.00) 1(1.22) 2(5.00)
χ2值   0.299 0.017 0.102 0.151 2.326
P值   0.585 0.897 0.750 0.628 <0.001
表4 2组患者术后满意度及住院费用比较
组别 例数 术后满意度[例(%)] 住院费用(万元,±s)
非常满意 满意 不满意 总满意率
试验组 42 26(61.9) 14(33.3) 2(4.8) 40(95.2) 1.52±0.23
对照组 40 25(62.5) 13(32.5) 2(5.0) 38(95.0) 2.45±0.35
χ2/t值   0.225 12.886
P值   0.635 <0.001
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