自制单孔通道在成人腹股沟疝腹腔镜手术中的应用评价

Evaluation of single-incision laparoscopic totally extra-peritoneal hernia repair by self-made path in adults with inguinal hernia

目的利用无菌手套及切口保护器自制单孔腹腔镜通道,进行成人腹股沟疝腹腔镜手术,并与常规三孔通道在应用价值、安全性及并发症等方面进行比较评估。方法纳入2017年7月至2019年3月中山大学附属第五医院胃肠外科行单侧或双侧完全腹膜外腹股沟疝修补术(TEP)的160例腹股沟疝患者,分为自制单孔组(SIL-TEP)及三孔组(MP-TEP),各80例,比较2组手术时间、并发症和疼痛视觉模拟量表评分(VAS)等。结果平均手术时间单孔组(86.06±33.69)min、三孔组(89.36±36.30)min,2组差异无统计学意义(P>0.05)。术后2 h VAS评分单孔组(1.89±0.84)分明显低于三孔组(2.36±1.25)分,差异有统计学意义(P=0.005);但术后24 h VAS评分[(1.55±0.50)分vs(1.63±0.48)分],差异无统计学意义(P>0.05)。术后并发症发生率单孔组23.8%、三孔组26.3%,差异无统计学意义(P>0.05)。随访6个月,单孔组无复发病例,三孔组2例疝复发。结论单孔腹腔镜TEP较三孔腹腔镜TEP的切口数量减少,术后即刻疼痛感减轻,未发生严重并发症,手术时间未明显延长。

Objective Using sterile gloves and incision protector,a single-hole laparoscopic path was developed to perform adult laparoscopic inguinal hernia repair.To assess the safety,efficacy and complications of self-made path single-incision laparoscopic totally extra-peritoneal hernia repair(SIL-TEP)compared with conventional multiple-port laparoscopic totally extra-peritoneal hernia repair(MP-TEP).Methods We enrolled 160 patients with inguinal hernia who underwent unilateral or bilateral TEP in the Department of Gastrointestinal Surgery of the Fifth Affiliated Hospital of Sun Yat Sen University from July 2017 to March 2019.Eighty patients underwent self-made path SIL-TEP,and 80 patients underwent MP-TEP.The operation time,complications and visual analogue pain scale(VAS)were compared between the two groups.Results There were no significant differences in mean operation time between the SIL-TEP and MP-TEP groups[(86.06±33.69)minvs(89.36±36.30)min,P>0.05].The postoperative 2 h VAS scores of SIL-TEP group was significantly lower than MP-TEP group[(1.89±0.84)vs(2.36±1.25),P=0.005],but postoperative 24 h VAS scores did not differ significantly between the two groups[(1.55±0.50)vs(1.63±0.48),P>0.05).The incidence of postoperative complications was similar between the SIL-TEP(23.8%)and MP-TEP groups(26.3%),P>0.05.We saw no recurrence at least 6-month follow-up in SIL-TEP group,and 2 recurrence in MP-TEP group.Conclusion Compared with MP-TEP,SIL-TEP had fewer incisions,milder postoperative pain scores,no severe complications,and similar operation time.