增强视野完全腹膜外疝修补术在下腹疝患者中的应用

Enhanced view-totally extraperitoneal technique for repair of lower abdomen hernias

目的探讨增强视野完全腹膜外疝修补术(enhanced-viewtotallyextraperitoneal technique,e-TEP)技术在下腹疝的应用价值,并阐述手术操作流程及技术细节,分析其可行性和有效性。方法收集2017年4月至2018年2月,腹股沟疝与下腹腹壁疝44例接受e-TEP手术患者的临床资料,其中南方医科大学附属何贤纪念医院患者35例,中山大学附属汕头市中心医院患者9例。手术适应征:各种疑难的腹股沟疝包括复发性腹股沟疝、嵌顿性腹股沟疝、阴囊疝、有下腹部手术史的或者脐部-耻骨距离短的腹股沟疝,还有各种下腹壁疝包括:耻骨上疝和下腹部切口疝。分析患者的围手术期情况及术后随访情况。结果本组患者均手术成功,无中转开放手术。平均手术时间65 min(35～125 min)。术后伤口疼痛轻,术后第1天平均疼痛视觉模拟评分2.0分(1～4分)。术后平均住院时间1.6 d(1～3 d)。术后3例出现阴囊血清肿,观察后自愈,未影响手术效果。术后随访时间3～13个月,未发现复发病例,无术后慢性疼痛病例。结论 e-TEP手术安全可行,创伤少,并发症少,拓展了TEP技术的适应证,是治疗各种下腹疝一种很好的技术补充。

Objective Investigating a novel minimally invasive approach（Enhanced-view Totally Extraperitoneal technique, e-TEP） to repair lower abdomen hernias. The procedure will be described in details and the safety and efficacy evaluated. Methods During October 2017 and August 2018, forty-four consecutive cases of lower abdomen hernias were repaired using the e-TEP procedure. Surgical indications of this series were complex inguinal hernias including the recurrent cases, incarcerated cases, large inguinoscrotal hernias, groin hernia patients with a short umbilical-pubic tubercle distance or who have a previous lower abdomen surgery history, as well as lower abdomen hernias such as suprapubic hernia and incisional hernia. Results All operations were successful without open conversion. The mean operative time was 65 minutes（35 to 125 minutes）. Postoperative pain was mild and the mean visual analogue pain scale（VAS） was 2.0 on first postoperative day. The average postoperative stay in hospital was 1.6 days（1 to 3 days）. Three cases experienced postoperative scrotal seroma but without adverse effect on the final outcome. Neither hernia recurrences nor long lasting postoperative pain were noted during the follow-up period of 3 to 13 months. Conclusions The e-TEP procedure is safe, feasible and minimally invasive for lower abdomen hernias. It expands the indications of TEP procedure which make it a good technical alternative for the treatment of lower abdomen hernias.