腹腔镜完全腹膜外疝修补术中手指引导下逆向穿刺法建立腹膜前间隙临床分析

Clinical analysis of establishing preperitoneal space by finger guided reverse puncture in laparoscopic totally extra-peritoneal hernia repair

目的探讨腹腔镜完全腹膜外疝修补术(TEP)中采用手指引导下逆向穿刺法建立腹膜前间隙方法的实用性、安全性。方法回顾性分析2016年10月至2019年10月,北部战区总医院261例TEP手术治疗腹股沟疝患者临床资料,术中均采用手指引导下逆向穿刺法建立腹膜前间隙。结果261例手术均成功完成,无中转开放手术,单侧建立腹膜前间隙时间(6.5±2.5)min。3例在逆向穿刺过程中出现肌肉出血,经压迫止血后出血停止;无腹壁下血管损伤、腹膜损伤及腹腔脏器损伤;无术后腹壁局部血肿。结论TEP术中手指引导下建立腹膜前间隙可有效地避免损伤腹壁下血管、腹膜及腹腔内组织,操作安全、可靠、便于掌握。逆向穿刺法建立腹膜前间隙便于进入正确的层次进行操作。

Objective To explore the practicability and safety of using finger-guided reverse puncture to establish the preperitoneal space in laparoscopic totally extra-peritoneal hernia repair(TEP).Methods The clinical data of 261 inguinal hernia patients treated with TEP surgery and establishing of preperitoneal space by finger-guided reverse puncture in the General Hospital of Northern Theater Command from October 2016 to October 2019 were retrospective analyzed.Results All 261 operations were successfully completed without conversion to open surgery,and the time for unilateral establishment of preperitoneal space was(6.5±2.5)min.Muscle bleeding occurred in 3 cases during reverse puncture,but the bleeding was stopped after compression hemostasis.There was no blood vessel injury under the abdominal wall,peritoneum injury,and abdominal organ injury.There was no local abdominal wall hematoma after operation.Conclusion The establishment of preperitoneal space under the guidance of fingers in TEP can effectively avoid the injury of blood vessels under the abdominal wall,peritoneum and intraperitoneal tissue.The operation is safe,reliable and easy to master.The reverse puncture method to establish the preperitoneal space facilitated access to the correct level for operation.