反向穿刺引导装置在腹腔镜全腹膜外疝修补术中的应用价值分析

Application value analysis of reverse puncture guide device in laparoscopic totally extraperitoneal hernia repair

目的:探讨反向穿刺引导装置在腹腔镜全腹膜外疝修补术(TEP)中完成套管穿刺的应用价值。方法:回顾分析2021年10月至2022年10月为80例腹股沟疝患者行TEP的临床资料,按手术方法分为实验组(n=40,采用反向穿刺引导装置完成第二、第三穿刺点的建立)与对照组(n=40,采用标准正向穿刺法),比较两组穿刺效果、手术相关指标及并发症。结果:78例患者完成TEP,实验组无中转手术,对照组2例中转为经腹腹膜前疝修补术。实验组腹直肌损伤率、腹壁小血管损伤导致出血率低于对照组,术中擦拭镜头次数少于对照组,建立腹膜前间隙时间、手术时间均短于对照组,差异有统计学意义(P<0.05)。两组腹膜穿破率、术后住院时间、术后12 h与24 h疼痛评分、术后并发症发生率差异无统计学意义(P>0.05)。结论:使用反向穿刺引导装置在TEP术中完成套管穿刺具有显著效果,能提高套管穿刺的安全性,降低腹直肌、腹壁小血管损伤率,缩短手术时间,利于TEP的推广与普及。

Objective:To explore the application value of reverse puncture guide device for completion of canula puncture in laparoscopic totally extraperitoneal hernia repair(TEP).Methods:Retrospective analysis was made on the clinical data of 80 patients with inguinal hernia who underwent TEP from Oct.2021 to Oct.2022,patients were divided into experimental group(n=40,using r everse puncture guidance device to complete the establishment of the second and third puncture points)and control group(n=40,u sing the standard forward puncture method).The effect of puncture,operation-related indicators and postoperative complications of two groups were compared.Results:TEP was completed in 78 patients,there was no transfer operation in the experimental group,and 2 c ases in the control group were converted to transabdominal preperitoneal repair.The abdominal rectus injury rate,the bleeding rate caused by small blood vessel injury in the abdominal wall,the times of wiping the lens during the operation,the time of establishment of the peritoneal anterior gap,and the operation time in the experimental group were less than those in the control group,the differences were statistically significant(P<0.05).There was no statistically significant difference between the two groups in peritoneal penetration rate,postoperative hospitalization time,postoperative pain score of 12 h and 24 h,and the incidence of complications(P>0.05).C onclusions:The use of reverse puncture guidance device to complete canula puncture in TEP has a significant effect,which can i mprove the safety of canula puncture,reduce the incidence of injury in the abdominal rectus muscle and small vessels in abdominal wall,and shorten the operation time.This procedure is conducive to promotion and popularization of TEP.