探讨腔镜下不同手术入路放置补片治疗腰疝的临床效果。

回顾性分析2015年5月至2021年5月在中国人民解放军联勤保障部队第九〇一医院采用腔镜下手术治疗的4例腰疝患者的临床资料，其中2例采用腹腔镜经腹部分腹膜外手术（TAPE）治疗，2例采用腹腔镜后腹腔入路完全腹膜外手术（R-TEP），观察不同手术方式的疗效。

4例患者均顺利完成手术。2例TAPE患者的手术时间均为70 min，2例R-TEP患者的为95 min、170 min（双侧）。2例TAPE患者术后24 h和48 h疼痛视觉模拟评分法（VAS）评分分别为4、3分和3、2分，2例R-TEP患者分别为2、2分和1分（病例3患者术后48 h内出院，未测量）；2例TAPE患者术后住院时间均为5 d，2例R-TEP患者的分别为1、2 d。2例TAPE患者术后排气时间均为2 d，2例R-TEP患者的均为1 d。所有患者均未出现术后发热、术区血肿、切口感染等并发症，术后疼痛患者均在3个月内缓解，随访36~84个月，无活动受限及复发患者。

两种术式治疗腰疝均有效，采用腹腔镜R-TEP可能更微创、术后恢复更快，花费更少，但仍需进一步研究论证。

To investigate the clinical efficacy of laparoscopic mesh repair via different surgical approaches for the treatment of lumbar hernia.

A retrospective analysis was performed on the clinical data of four patients with lumbar hernia who underwent laparoscopic surgery at the 901st Hospital of the Joint Logistics Support Force of the PLA between May 2015 and May 2021. Two patients underwent laparoscopic trans-abdominal partial extra-peritoneal (TAPE), while the remaining two received laparoscopic retroperitoneal totally extraperitoneal surgery (R-TEP). The therapeutic outcomes of different laparoscopic approaches were evaluated.

All four patients successfully completed surgery. The operative time was 70 minutes for both patients who received TAPE, while that for the 2 R-TEP patients was 95 minutes and 170 minutes (bilateral case), respectively. The visual analog scale (VAS) pain scores at 24 and 48 hours postoperatively were 4, 3 points and 3, 2 points for the 2 TAPE patients, and 2, 2 points and 1 point(for case 3, the patient was discharged within 48 hours after surgery, and the corresponding measurement was not conducted) for the 2 R-TEP patients, respectively. The postoperative hospital stay was 5 days for both TAPE patients, compared with 1 day and 2 days for the R-TEP patients. The time to first postoperative flatus was 2 days in both TAPE patients and 1 day in both R-TEP patients. No complications such as fever, operative-site hematoma or incision infection were observed. Postoperative pain in all patients resolved within 3 months. During a follow-up period of 36-84 months, no activity limitation or hernia recurrence was reported.

Both surgical approaches are effective in the treatment of lumbar hernia. Laparoscopic R-TEP may be more minimally invasive, associated with faster postoperative recovery and lower costs, but further research and verification are still required.