单侧布孔外侧入路法在经腹腹膜前疝修补术中的应用研究

Application of unilateral trocar arrangement combined with lateral approach in transabdominal preperitoneal inguinal hernia repair

目的观察单侧布孔外侧入路法在腹腔镜经腹腹膜前疝修补术(TAPP)中的效率和效果。方法选择2018年1月至2019年1月在南部战区总医院普通外科行TAPP治疗的62例符合入选标准的腹股沟疝患者。采用随机数字表法分为2组:对照组30例,采用七步法完成手术;试验组32例,采用单侧布孔外侧入路法完成手术。比较2组患者年龄、性别、体质量指数、疝类型、疝囊处理方式、手术时间、手术出血量、术后并发症发生率、复发率等。结果试验组平均手术时间为(48.47±7.34)min,对照组为(64.57±7.51)min,2组差异有统计学意义(t=-8.537,P<0.001);2组在年龄、性别、体质量指数、疝类型、疝囊处理方面差异无统计学意义(P>0.05);2组在血清肿发生率、术中出血量、术后视觉模拟评分方面差异无统计学意义(P>0.05);观察期内2组术后均无补片感染、疝复发病例。结论相对于七步法,单侧布孔外侧入路法在TAPP术中能缩短手术时间,不增加术中出血量、术后并发症发生率、疝复发率。

Objective To observe the efficiency and effect of applying unilateral trocar arrangement combined with lateral approach in laparoscopic trans-abdominal preperitoneal hernia repair(TAPP).Methods From January 2018 to January 2019,62 patients with inguinal hernia who met the inclusion criteria and underwent TAPP in the Department of General Surgery of Southern Theater General Hospital.All the eligible patients were randomly divided into two groups by random number table method:the control group(30 cases)was operated with the conventional―seven-step‖procedure,while the experimental group(32 cases)was operated with unilateral trocar arrangement combined with lateral approach.The two groups were compared in terms of age,gender,body mass index(BMI),hernia type,hernia sac management method,operation time,intra-operative blood loss,postoperative complications and recurrence rate.Results The average operation time of the experimental group and the control group was(48.47±7.34)min and(64.57±7.51)min,respectively,and the difference between the two groups was statistically significant(t=-8.537,P<0.001).There were no significant differences in age,gender,BMI,hernia type and hernia sac management between the two groups(P>0.05).There were no significant differences in terms of incidence of seroma,intra-operative blood loss and postoperative VAS score(P>0.05).There were no cases of mesh infection or hernia recurrence after operation in the two groups by the end of observation.Conclusion Compared with the conventional―seven-step‖procedure,the unilateral trocar arrangement combined with lateral approach could reduce operation time in TAPP,without increasing the intra-operative blood loss,postoperative complications and hernia recurrence.