经皮内环补片单点固定法全腹膜外腹腔镜腹股沟疝修补术临床应用研究

The clinical application study of laparoscopic totally extraperitoneal inguinal hernia repair using percutaneous internal ring mesh-single-site fixation

目的:探讨完全腹膜外腹腔镜腹股沟疝修补术(TEP)补片固定新方法——经皮内环补片单点固定法,评估其可行性、安全性、经济性。方法:前瞻性收集2017年3月至2018年3月行TEP的患者,符合入组标准的患者随机分为经皮内环补片单点固定法组(s-TEP)与补片免固定组(n-TEP),对比分析两组手术时间、术后住院时间、住院总费用及术后血清肿/血肿、感染、排尿困难、复发情况。结果:两组患者一般资料差异无统计学意义,手术均顺利完成,无一例中转手术。s-TEP组较n-TEP组手术时间短,差异有统计学意义;两组术后住院时间、总住院费用差异无统计学意义。s-TEP组发生血肿/血清肿5例,排尿困难2例;n-TEP组发生血肿/血清肿8例,感染1例,排尿困难2例,复发1例/1侧,两组并发症发生率、复发率差异无统计学意义。结论:采用经皮内环补片单点固定法,在不增加住院费用的同时明显缩短了手术时间,降低了手术难度,操作简单易行,具有良好的可行性、安全性、实用性。

Objective:To explore a novel method of mesh fixation in laparoscopic totally extraperitoneal(TEP)inguinal hernia repair--percutaneous internal ring mesh-single-site fixation,and assess its feasibility,safety and economics.Methods:A prospective collection was conducted from Mar.2017 to Mar.2018,and the patients were randomly divided into single-stapling TEP(s-TEP)and non-stapling TEP(n-TEP),the operative time,postoperative hospital stay,total hospitalization costs,hematoma/seroma,infection,dysuria,and recurrence of the two groups were comparatively analyzed.Results:The general data of the two groups were comparable,all the operations were successfully completed without conversion.The s-TEP group had shorter operation time than the n-TEP group,the difference was statistically significant.There was no significant difference in postoperative hospital stay or total hospitalization costs between the s-TEP group and the n-TEP group.In the s-TEP group,there were 5 cases of hematoma/seroma and 2 cases of dysuria.However,there were 8 cases of hematoma/seroma,1 case of infection,2 cases of dysuria,1 case/1 side of recurrence in the n-TEP group.There was no significant difference in incidence of complications or recurrence between the two groups.Conclusions:Percutaneous internal ring mesh-single-site fixation can significantly shorten the operation time and reduce the difficulty of operation without increasing the hospitalization costs,simultaneously,it is simple and has good feasibility,safety and practicability.