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 (04) : 410 -413. doi: 10.3877/cma.j.issn.1674-392X.2024.04.010

论著

改良医用胶粘合假疝囊技术预防腹腔镜完全腹膜外疝修补术后血清肿的临床研究
申亚伟1, 黄新1,(), 李万林1   
  1. 1. 710000 西安市中心医院肝胆疝与腹壁外科
  • 收稿日期:2022-09-19 出版日期:2024-08-18
  • 通信作者: 黄新

Clinical study on the prevention of seroma after laparoscopic totally extraperitoneal hernia repair by modified medical adhesive and pseudohernia sac technique

Yawei Shen1, Xin Huang1,(), Wanlin Li1   

  1. 1. Department of General Surgery, Xi'an Central Hospital, Xi'an 710000, China
  • Received:2022-09-19 Published:2024-08-18
  • Corresponding author: Xin Huang
引用本文:

申亚伟, 黄新, 李万林. 改良医用胶粘合假疝囊技术预防腹腔镜完全腹膜外疝修补术后血清肿的临床研究[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(04): 410-413.

Yawei Shen, Xin Huang, Wanlin Li. Clinical study on the prevention of seroma after laparoscopic totally extraperitoneal hernia repair by modified medical adhesive and pseudohernia sac technique[J/OL]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2024, 18(04): 410-413.

目的

分析改良医用胶粘合假疝囊技术预防直疝腹腔镜完全腹膜外疝修补术(TEP)后血清肿的临床效果。

方法

选择2019年2月至2021年3月西安市中心医院肝胆疝与腹壁外科收治的腹股沟直疝患者93例,采用随机数表法随机分为2组。其中试验组患者47例,采用改良医用胶粘合假疝囊技术;对照组患者46例,采用3-0可吸收缝线连续缝合假疝囊,2组均随访至术后12个月。观察2组患者的手术时间、术中出血量、下床时间、平均住院时间、住院费用、术区感染、血清肿发生率、早期疼痛及慢性疼痛发生率。

结果

试验组在术中出血量、住院时间、住院费用方面和对照组比较,差异无统计学意义(P>0.05);试验组手术时间明显短于对照组,差异有统计学意义(P<0.05)。试验组下床时间明显长于对照组,差异有统计学意义(P<0.05)。试验组和对照组术后均未发生术区感染;对照组有4例患者发生慢性疼痛,试验组无患者发生慢性疼痛,差异有统计学意义(P<0.05)。试验组血清肿发生率4.25%(2/47)低于对照组23.91%(11/46),差异有统计学意义(P<0.05)。试验组术后腹股沟区早期疼痛发生率2.13%(1/47)低于对照组13.04%(6/46),差异有统计学意义(P<0.05)。

结论

改良医用胶粘合假疝囊技术预防TEP术后血清肿的方法,简单易行、安全可靠。

Objective

To analyze the clinical effect of modified medical adhesive pseudohernia sac technique in preventing seroma after totally extraperitoneal hernia repair (TEP) for direct hernia.

Methods

From February 2019 to March 2021, 93 patients with direct inguinal hernia who were admitted to Department of Hepatobiliary Hernia and Abdominal Wall Surgery, Xi'an Central Hospital were randomly divided into two groups by random number table method. Among them, 47 patients in experimental group were treated with modified medical adhesive pseudohernia sac technology, and 46 patients in the control group were sutured with 3-0 absorbable suture continuously. Both groups were followed up to 12 months after operation. The operation time, intraoperative bleeding, time out of bed, average hospitalization time, hospitalization cost, operation area infection, incidence of seroma, early pain and chronic pain were observed in 2 groups.

Results

There was no significant difference between the experimental group and the control group in terms of intraoperative bleeding, hospital stay, and hospital costs (P>0.05); The operation time of the experimental group was significantly shorter than that of the control group (P<0.05). The time of getting out of bed in experimental group was significantly longer than that in control group (P<0.05). There was no postoperative infection in the operation area in the experimental group and the control group. There were 4 patients in the control group who had chronic pain, and no patient in the experimental group who had chronic pain, the difference was statistically significant (P<0.05). The incidence of seroma in the experimental group was 4.25% (2/47), which was significantly lower than that in the control group 23.91% (11/46; P<0.05). The incidence of early postoperative pain in the groin area in the experimental group was 2.13% (1/47), which was significantly lower than that in the control group 13.04% (6/46; P<0.05).

Conclusion

The modified medical adhesive pseudohernia sac technique to prevent seroma after laparoscopic TEP hernia repair is simple, safe and reliable.

图1 医用胶粘合假疝囊过程注:1A为剔除直疝缺损周边的脂肪组织;1B为疝囊周边360°粘合;1C为助手从体表按压假疝囊,补片与假疝囊腹横筋膜进行粘合。
表1 2组患者手术情况比较(±s
表2 2组患者术后并发症比较[例(%)]
[1]
黄敏, 武建, 汪为林, 等. 腹腔镜腹股沟疝修补术后血清肿的危险因素及防治[J]. 腹腔镜外科杂志, 2019, 24(4): 304-307.
[2]
Reiner MA, Bresnahan ER. Laparoscopic total extraperitonealhernia herrnia repair outcomes[J]. JSLS, 2016, 20(3): e2016. 00043.
[3]
钟飞庄, 翁山耕, 林其声, 等. 腹腔镜全腹膜外腹股沟疝修补术精索壁化的解剖学观察及临床意义[J]. 腹腔镜外科杂志, 2019, 24(10): 742-745.
[4]
中华医学会外科学分会疝与腹壁外科学组, 中华医学会外科学分会腹腔镜与内镜外科学组, 大中华腔镜疝外科学院. 腹腔镜腹股沟疝手术操作指南(2017版)[J/OL]. 中华疝和腹壁外科杂志(电子版), 2017, 11(6): 401-406.
[5]
Miserez M, Alexandre JH, Campanelli G, et al. The European hernia society groin hernia classification: simple and easy to remember[J]. Hernia, 2007, 11(2): 113-116.
[6]
史剑峰, 沈红岩. 腹腔镜疝修补术与开放式无张力疝修补术治疗成人腹股沟疝的疗效观察[J/OL]. 临床普外科电子杂志, 2022, 10(3): 111-114.
[7]
黄敏, 武建, 汪为林, 等. 腹腔镜腹股沟疝修补术后血清肿的危险因素及防治[J]. 腹腔镜外科杂志, 2019, 24(4): 304-307.
[8]
李海风, 战俊, 滕世岗, 等. 腹腔镜完全腹膜外疝修补术后血清肿的危险因素分析[J]. 中国医师进修杂志, 2022, 45(9): 834-838.
[9]
Ivanov II, Honda K. Intestinal commensal microbes as immune modulators[J]. Cell Host Microbe, 2012, 12(4): 496-508.
[10]
中华医学会外科学分会疝与腹壁外科学组, 中国医师协会外科医师分会疝和腹壁外科医师委员会. 成人腹股沟疝诊断和治疗指南(2018年版)[J]. 中国普通外科杂志, 2018, 27(7): 803-807.
[11]
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.
[12]
Tulin A, Slavu I, Braga V, et al. TAAP vs. TEP in Inguinal Hernia Repair-What is the Evidence? A Single Center Experience[J]. Chirurgia(Bucur), 2019, 114(1): 67-72.
[13]
王章菊, 李德方. 腹腔镜腹股沟疝修补术后血清肿的影响因素分析[J]. 浙江创伤外科, 2022, 24(3): 543-544.
[14]
吴明东, 刘俊杰, 喻武, 等. 生物补片应用于腹腔镜全腹膜外成人腹股沟疝修补的疗效分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2022, 16(5): 525-530.
[15]
高治华, 黄金, 刘子豪, 等. 腹腔镜经腹腔腹膜前疝修补术后形成血清肿风险综合预测模型的建立[J]. 安徽医学, 2022, 43(10): 1196-1199.
[16]
付焱, 李恒. 腹腔镜腹股沟直疝修补术中假性疝囊处理的临床研究[J/OL]. 中华疝和腹壁外科杂志(电子版), 2019, 13(1): 58-61.
[17]
缪小飞, 胡行前, 王彤. 腹腔镜直疝修补术中假疝囊固定于耻骨梳韧带的临床研究[J]. 腹腔镜外科杂志, 2022, 27(9): 655-658.
[18]
莫宇轩, 汤凌佳. 倒刺线缝合假性疝囊预防直疝术后血清肿应用研究[J]. 岭南现代临床外科, 2022, 22(4): 363-368
[19]
林武, 郑立, 邱春梅, 等. Endoclose针结扎假疝囊预防腹腔镜完全腹膜外直疝修补术后血清肿的效果分析[J]. 临床外科杂志, 2020, 28(10): 958-961.
[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