探讨腹腔镜下完全腹膜外补片修补术（TEP）治疗成人脐疝的临床效果。

本回顾性队列研究纳入2022年2月至2025年2月汉中市人民医院收治的脐疝患者76例作为研究对象。依据治疗方法的不同分为对照组（n=33）和观察组（n=43），对照组行腹腔镜腹腔内补片修补术（IPOM），观察组行腹腔镜下TEP。比较2组患者的手术相关指标、疼痛视觉模拟评分法（VAS）评分、胃肠功能恢复情况、应激因子指标、外周血炎症因子指标、并发症与复发情况。

观察组较对照组手术时间延长8.16 min（95% CI 0.74~15.58 min）、术中出血量增加0.84 ml（95% CI 0.12~1.56 ml）、术后首次下床时间提前1.37 h（95% CI －2.33~－0.41 h），差异均有统计学意义（P<0.05）。重复测量方差分析整体结果显示，疼痛VAS评分时间、组间、交互效应均显著（F_时间=454.7、F_组间=15.22、F_交互=3.079，P均<0.05），2组疼痛均随时间推移明显减轻，观察组显著低于对照组。进一步对各时间点进行简单效应分析发现，观察组术后1 d、1周疼痛VAS评分更低（P<0.05）。观察组较对照组首次肛门排气时间、首次排便时间、肠鸣音恢复时间、恢复进食时间均提前，分别为0.81 h（95% CI －1.51~－0.11 h）、2.73 h（95% CI －4.62~－0.84 h）、1.12 h（95% CI －2.11~－0.13 h）、1.34 h（95% CI －2.30~－0.38 h），差异均有统计学意义（P<0.05）。术后1 d，2组患者的血清肾上腺素、皮质醇、去甲肾上腺素均升高，但观察组较对照组血清肾上腺素、皮质醇、去甲肾上腺素均低，分别为8.08 pg/ml（95% CI －14.18~－1.98 pg/ml）、10.69 nmol/L（95% CI －21.05~－0.33 nmol/L）、7.07 pg/ml（95% CI －12.61~－1.53 pg/ml），差异均有统计学意义（P<0.05）。术后3个月，2组均未出现不全性肠梗阻及复发，总并发症发生率比较，差异无统计学意义（P>0.05）。

对比IPOM，腹腔镜下TEP治疗成人脐疝在促进早期活动、减轻术后早期疼痛方面更具优势，可降低应激水平，且安全性良好。

To evaluate the clinical efficacy of laparoscopic total extraperitoneal patch repair (TEP) in the treatment of adult umbilical hernia.

A retrospective cohort study was conducted including 76 patients with umbilical hernias admitted to Hanzhong People's Hospital between February 2022 and February 2025. Patients were assigned to a control group (n=33) and an observation group (n=43). The control group underwent laparoscopic intraperitoneal onlay mesh (IPOM), whereas the observation group underwent laparoscopic TEP. The surgery-related indicators, visual analog scale (VAS) pain score, gastrointestinal function recovery, stress factor indicators, peripheral blood inflammatory factor indicators, complications and recurrence were compared between the two groups.

The observation group had a significantly longer operative time (8.16, 95% CI 0.74–15.58 min) and intraoperative blood loss (0.84, 95% CI 0.12–1.56 ml) compared to the control group, while showing shorter postoperative first out-of-bed time (-1.37, 95% CI -2.33–-0.41 h) (P<0.05). Repeated-measures analysis of variance (ANOVA) for pain VAS scores showed significant main effects of time, group, and their interaction (F_time=454.7, F_group=15.22, F_interaction=3.079; all P<0.05). The overall pain level in the observation group was significantly lower than that in the control group, and pain relief was more rapid in the observation group. For simple effects analysis at each time point revealed that the observation group had significantly lower pain VAS scores at postoperative day 1 and postoperative week 1 (P<0.05). All parameters including first anal gas expulsion time (-0.81, 95% CI -1.51–-0.11 h), first bowel movement time (-2.73, 95% CI -4.62–-0.84 h), intestinal sound recovery time (-1.12, 95% CI -2.11–-0.13 h), and resumption of feeding time (-1.34, 95% CI -2.30–-0.38 h) were significantly shorter in the observation group (P<0.05). On postoperative day 1, serum levels of epinephrine (-8.08, 95% CI -14.18–-1.98 pg/ml), cortisol (-10.69, 95% CI -21.05–-0.33 nmol/L), and noradrenaline (-7.07, 95% CI -12.61–-1.53 pg/ml) were elevated in both groups compared to preoperative levels, with the observation group showing lower values than the control group (P<0.05). No cases of incomplete intestinal obstruction or hernia recurrence were observed in either group at 3 months postoperatively, and there was no statistically significant difference in overall complication rates (P>0.05).

Compared with IPOM, laparoscopic TEP in the treatment of adult umbilical hernia offers advantages in promoting early ambulation and reducing early postoperative pain, is associated with reduced stress levels, and demonstrates a favorable safety profile.