腹腔镜完全腹膜外疝修补术治疗有阑尾切除手术史右侧腹股沟疝可行性分析

Feasibility analysis of laparoscopic totally extraperitoneal hernia repair for the right inguinal hernia with history of appendectomy

目的探讨腹腔镜完全腹膜外疝修补术(TEP)治疗有阑尾切除手术史右侧腹股沟疝的可行性、安全性。方法回顾性分析2020年9月至2022年9月,中国人民解放军联勤保障部队第九九一医院普通外科收治的行TEP治疗的73例右侧或双侧腹股沟疝患者的临床资料,根据是否有阑尾切除术史,分为研究组(阑尾切除术后组)和对照组(无手术史组),对比分析2组手术相关指标、术后疼痛程度、术后恢复情况、住院总费用及并发症发生率等指标。结果2组手术均获成功,无围手术期死亡。2组手术时间、术中出血量、疝囊直径、腹膜破损发生率、术中腹膜破损数量、医用胶水使用率、塑料夹使用数量等差异无统计学意义(P>0.05)。研究组无中转经腹腹膜前疝修补术或开放手术病例,对照组有2例中转经腹腹膜前疝修补术,但2组比较差异无统计学意义。2组患者术后当日、术后次日疼痛评分、术后疼痛持续天数等差异无统计学意义(P>0.05)。2组患者术后下床活动时间、术后住院天数、恢复正常活动时间及住院总费用差异无统计学意义。研究组发生血清肿2例,膀胱损伤1例,对照组发生血清肿5例,无膀胱损伤。全组随访时间2~24个月,中位随访时间6个月,2组均无慢性疼痛,研究组无疝复发,对照组1例疝复发。2组术后并发症发生率差异无统计学意义(P>0.05)。结论TEP是治疗阑尾切除术后右侧腹股沟疝安全可行的手术方式。

Objective To analyze the feasibility and safety of laparoscopic totally extraperitoneal hernia repair in the treatment of the right inguinal hernia with history of appendectomy.Methods From September 2020 to September 2022,the clinical data of 73 patients with right or bilateral inguinal hernia who underwent laparoscopic totally extraperitoneal hernia repair(TEP)at the General Surgery Department of the 991st Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army was retrospectively analyzed.According to whether they had a history of appendectomy,they were divided into a study group(after appendectomy group)and a control group(without surgery history group).The operation-related indicators,,postoperative pain degree,postoperative recovery,total hospitalization cost,and incidence of complications were compared between the two groups.Results All the patients in the two groups successfully underwent TEP with no perioperative death;the operative time,intraoperative blood loss,hernia sac diameter,incidence of intraoperative peritoneal injury,number of intraoperative peritoneal injuries,amount of plastic clamp used and incidence of medical glue used in the two groups were not statistically significant(P>0.05).No case in the study group was converted to the transabdominal preperitoneal hernia repair(TAPP)or open surgery,and 2 cases in the control group were converted to TAPP,but there was no significant difference in the convert rate between the two groups(P=0.504).There was no significant difference in the time to get out of bed,postoperative hospital stay,or total hospitalization cost between the two groups.There was no significant difference in the VAS score of the postoperative day,the VAS score of the next day,or the postoperative pain duration between the two groups.There were 2 cases of seroma and 1 case of bladder injury in the study group,and 5 cases of seroma and no bladder damage in the control group.In all cases,the follow-up time was 2 to 24 months,and the middle follow-up time was six months.There was no chronic pain in either group.There was no recurrence in the study group,but one recurrence in the control group.There was no significant difference in the incidence of postoperative complications between the two groups(P>0.05).Conclusion TEP is safe and feasible in the treatment of the right inguinal hernia with a history of appendectomy.