“空气置换法”在腹腔镜腹股沟嵌顿疝手术中的应用

Application of “air replacement” in laparoscopic operation of incarcerated inguinal hernia

目的:探讨“空气置换法”在腹腔镜腹股沟嵌顿疝中的应用价值。方法:采用回顾性横断面的研究方法,收集2016年3月至2019年2月收治的48例行腹腔镜腹股沟嵌顿疝手术患者的临床资料。将患者分为两组,常规组(主要采用“内拉外推”的方法还纳疝内容物)与置换组(采用单腔尿管经疝环口向疝囊内注入空气,再配合“内拉外推”法还纳疝内容物)。如果无法还纳疝内容物或还纳过程中损伤嵌顿肠管,则中转开放。对比两组还纳疝内容物成功率、还纳时间、疝内容物损伤率及中转开放率。结果:置换组还纳疝内容物成功率(89.3%vs.60%)高于常规组,还纳时间[(14.64±1.81)min vs.(18.20±1.77)min]短于常规组,疝内容物损伤率(21.4%vs.50%)、中转开放率(10.7%vs.40%)低于常规组,差异有统计学意义。结论:“空间置换”协助腹腔镜下还纳嵌顿的腹股沟疝内容物是安全、有效的,值得临床推广。

Objective:To investigate the application value of“air replacement”in laparoscopic operation of incarcerated inguinal hernia.Methods:Retrospective analysis was made on the clinical data and therapeutic effect of 48 patients with incarcerated inguinal hernia who were treated by laparoscopic operation from Mar.2016 to Feb.2019.The patients were divided into two groups:the conventional group mainly used the method of“inner pull-out”to return the hernia contents,and the replacement group used a single-lumen catheter to inject air into the hernia sac through the hernia ring,and then cooperated with“inner pull-out”.If the contents could not be returned or the incarcerated intestine was damaged during the procedure,the operation would be turned to open approach.Success rate of returning the contents,time of returning,the rate of damage to the contents and the rate of turning to open surgery were compared between the two groups.Results:Compared with the conventional group,the replacement group had a higher odds of success to return the hernia contents(89.3%vs.60%),shorter time of returning[(14.64±1.81)min vs.(18.20±1.77)min],lower damage rate(21.4%vs.50%)and open approach rate(10.7%vs.40%).There was a statistically substantial difference.Conclusions:It is a safe and effective way to treat incarcerated inguinal hernia using laparoscopic operation assisted with“space replacement”.