外下入路切开腹横筋膜后层在完全腹膜外腹腔镜疝修补术中的应用

Application of Lateral Inferior Incision in Transever Fascia Posteriorlayer in Totally Extraperitoneal Laparoscopic Hernia Repair

目的探讨外下入路切开腹横筋膜后层建立腹膜前间隙应用于完全腹膜外腹腔镜疝修补术(TEP)在减少腹膜破损中的应用价值.方法选取2020年1月—2022年6月华南理工大学附属第六医院收治的186例腹股沟疝者为研究对象,根据随机数字表法分为对照组与观察组.两组患者均行中线位TEP,观察组(n=93)外下入路切开腹横筋膜后层建立腹膜前间隙,对照组(n=93)半环线下方切开腹横筋膜后层建立腹膜前间隙.比较两组的腹膜破损发生部位及发生率、手术时间.结果观察组腹膜破损发生率低于对照组,差异有统计学意义(P<0.05).其中,两组建立腹膜前间隙时腹膜破损发生率比较,差异有统计学意义(P<0.05);剥离疝囊时及精索腹壁化时腹膜破损发生率比较,差异无统计学意义(P>0.05).观察组手术时间为(33.30±24.60)min,短于对照组的(42.60±28.50)min,差异有统计学意义(P<0.05).结论外下入路切开腹横筋膜后层建立腹膜前间隙在TEP中是可行的,腹膜破损概率小,手术时间短,值得临床应用与推广.

Objective To explore the value of lateral inferior incision in transeverfascia posteriorlayer in totally extraperitoneal laparoscopic hernia repair(TEP).Methods A total of 186 patients with inguinal hernia who were admitted to the hospital from January 2020 to June 2022 were selected as the research objects,and they were divided into control group and observatiol group according to the random number table method.The observation group(n=93)were underwent TEP with lateral inferior incision in transever fascia posteriorlayer,and the control group(n=93)were underwent TEP with incision in transever fascia posteriorlayer below the Semicircular Line.The incidence of peritoneal rupture and surgical time between the two groups were compared.Results The incidence of peritoneal rupture in the observation group was lower that that in the control group,and the difference was statistically significant(P<0.05).Among them,there was a statistically significant difference in the incidence of peritoneal damage between the two groups when establishing a pre peritoneal space(P<0.05);there were no statistically significant differences in the incidence of peritoneal damage between the two groups of patients during hernia sac dissection and spermatic cord abdominization(P>0.05).The surgical time in the observation group was(33.3±24.6)minutes,which was shorter than(42.60±28.50)minutes in the control group,and the difference was statistically significant(P<0.05).Conclusions Lateral inferior incision in transever fascia posteriorlayer in TEP is feasible and associated with low probability of peritoneal tear,which should be popularized in clinic.