探讨增强视野下腹腔镜完全腹膜外修补术（e-TEP）与腹腔内补片修补术（IPOM）治疗成人脐疝的疗效。

本研究为回顾性队列研究。回顾性分析2020年1月至2023年12月于安徽医科大学附属六安医院普外科行手术治疗的19例脐疝患者临床资料，根据手术方法的不同分为e-TEP组（接受e-TEP手术治疗，n=10）和IPOM组（接受IPOM手术治疗，n=9）。对比分析2组患者的手术时间、住院时间、住院费用，术后6个月内疼痛情况及术后12个月内并发症发生情况。

与IPOM组比较，e-TEP组平均手术时间更长[（125.50±8.96）min比（74.44±9.17）min]、术后平均住院时间更短[（3.90±0.74）d比（6.89±0.78）d]、平均住院费用更低[（10 315.09±676.64）元比（27 581.12±1432.92）元]，差异均有统计学意义（P<0.001）。经双因素重复测量方差分析显示，与IPOM组比较，eTEP组术后各时间点疼痛视觉模拟评分法（VAS）评分均更低，2组整体疼痛评分比较，差异有统计学意义（F_组间=104.31，P_组间<0.001）；两组疼痛评分均随术后时间延长呈下降趋势（F_时间=120.50，P_时间<0.001）。手术方式与时间存在显著交互作用（F_交互=68.22，P_交互<0.001）。组间同一时间点比较采用Bonferroni法进行事后多重比较，在术后各时点（1、3、7、15 d及1、3、6个月），eTEP组疼痛评分均显著低于IPOM组（P<0.001）。术后随访12个月，无失访病例，随访期间无疝复发、切口感染及血清肿病例，1例IPOM组患者术后出现便秘、肠梗阻症状，考虑术后粘连性肠梗阻可能性较大，通过改善饮食症状得到缓解。

腹腔镜e-TEP术后疼痛更轻、恢复更快，但手术操作时间更长；IPOM手术难度较低，但术后疼痛更明显，且整体费用偏高，临床需根据术者熟练程度及患者经济情况进行选择。

To evaluate the efficacy of laparoscopic enhanced-view totally extraperitoneal repair (e-TEP) versus intraperitoneal onlay mesh repair (IPOM) in the treatment of adult umbilical hernia.

This study was a retrospective cohort study. The clinical data of 19 umbilical hernia patients in Lu'an People's Hospital from January 2020 to December 2023 were retrospectively analyzed. These patients were divided into an e-TEP group (undergoing laparoscopic enhanced view totally extra peritoneal repair, n=10) and an IPOM group (receiving laparoscopic intraperitoneal onlay mesh repair, n=9). The operation time, length of hospital stay, hospitalization expenses, postoperative pain within 6 months, and incidence of complications within 12 months postoperatively were observed and compared between the two groups.

Compared with the IPOM group, the e-TEP group had a longer mean operative time [(125.50±8.96) minutes vs. (74.44±9.17) minutes], a shorter mean postoperative hospital stay [(3.90±0.74) days vs. (6.89±0.78) days], and a lower mean hospitalization cost [(10 315.09±676.64) yuan vs. (27 581.12±1432.92) yuan], with all differences being statistically significant (P<0.001). Two-way repeated- measures ANOVA showed that compared with the IPOM group, the e-TEP group had lower pain scores (VAS) at all postoperative time points, and the difference in overall pain scores between the two groups was statistically significant (F_group=104.31, P_group<0.001). The pain scores in both groups decreased with the prolongation of postoperative time (F_time=120.50, P_time<0.001), and there was a significant interaction between operation method and time (F_interaction=68.22, P_interaction<0.001). Post hoc multiple comparisons between groups at the same time points were conducted using the Bonferroni method. At each postoperative time point (1, 3, 7, 15 days, and 1, 3, 6 months), the pain score in the eTEP group was significantly lower than that in the IPOM group (P<0.001). During the 12-month follow-up period, no patients were lost to follow-up. There were no cases of hernia recurrence, incision infection, or seroma in either group. One patient in the IPOM group developed constipation and intestinal obstruction postoperatively. Postoperative adhesive intestinal obstruction was considered highly likely, and the symptoms were relieved by dietary modification.

Laparoscopic e-TEP is associated with less postoperative pain and faster recovery but requires a longer operative time. In contrast, IPOM is technically less demanding but is associated with more pronounced postoperative pain and higher overall costs. The choice of surgical approach should be based on the surgeon's proficiency and the patient’s economic status.