自制简易单孔器行单孔腹腔镜全腹膜外腹股沟疝修补术

Single-incision laparoscopic surgery with self-made port for totally extraperitoneal hernioplasty:a report of 7 cases

目的：探讨采用自制简易单孔器行单孔腹腔镜全腹膜外腹股沟疝修补术（ SILS－TEP术）的安全性和可行性。方法：病例来自2013年2～4月浙江大学医学院附属邵逸夫医院普外科。采用一次性切口牵开固定器、无菌手套和普通腹腔镜套管制成简易单孔器，使用常规腹腔镜器械对7例腹股沟疝患者行SILS－TEP术，总结患者的临床资料和随访结果。结果：全部7例（9侧）腹股沟疝患者均行SILS－TEP术成功，中位手术时间90．0（70～125） min，中位出血量10．0（5．0～20．0） mL，中位住院天数2．0（2．0～4．0） d，术后患者疼痛轻微，无围手术期并发症。随访3个月切口愈合佳，均无复发及其他并发症发生。结论：采用自制简易单孔器行SILS－TEP术初步经验显示安全可行，该方法能简化单孔手术器械，减轻患者经济负担，易于基层医院推广应用。

Objective： To explore the feasibility of single-incision laparoscopic totally extraperitoneal hernioplasty （ SILS-TEP ） with self-made port for repairing of inguinal hernia .Methods： SILS-TEP was performed in 7 inguinal hernia patients （ 9 sides） with conventional laparoscopic instruments and self-made port, which composed of a wound retractor , surgical gloves and 3 ordinary trocars .The clinical data and fellow-up results of 7 cases were retrospectively collected and analyzed .Results： The self-made port was applied for SILS-TEP uneventfully without the need of additional ports in all 7 patients （9 inguinal hernias）.The median operating time was 90.0 （70-125） min, intraoperative blood loss was 10.0 （ 5.0 -20.0 ） mL and postoperative hospital stay was 2.0 （ 2.0 -4.0 ） d.The median pain scores of visual analog scale （VAS） at 6 h,12 h, 24 h and 14 d were 3（2～4）, 2（1～2）, 1（0～2） and 0（0～1 ） , respectively .There were no intraoperative complications reported , and all patients were satisfied with wound healing . No hernia recurrence was observed during the 3-months of follow-up.Conclusion： Our initial experiences show that SILS-TEP with self-made port is s safe and feasible surgery , which can simplify the procedure with available equipments and reduce the cost , therefore can be applied in grass-root hospitals .