双腹腔镜TEP技术在腹股沟疝治疗中的应用价值

Application value of totally extraperitoneal prosthesis with two laparoscopes intreatment of inguinal hernia

目的探讨应用双腹腔镜技术的完全腹膜外腹股沟疝修补术(双腹腔镜TEP)在腹股沟疝外科治疗中的价值。方法回顾性分析2016年8月至2018年6月合肥市第一人民医院微创外科收治的腹股沟疝患者91例,根据手术方法不同分为观察组51例(应用双腹腔镜TEP术)和对照组40例(应用完全腹膜外腹股沟疝修补术,即TEP术)。比较两组患者手术一般情况(手术时间、术后住院时间、术中对侧隐匿性疝检出情况、术中嵌顿疝内容物探查情况),术后局部血清肿发生率及复发率。结果观察组手术时间为(59.76±11.63)min,术后住院时间为(4.23±1.05)d,与对照组[(57.45±11.03)min、(4.22±1.27)d]比较,差异均无统计学意义(P>0.05);观察组术中探查出对侧隐匿性疝7例,探查到嵌顿疝内容物12例,优于对照组(0例、0例),差异有统计学意义(P<0.05);观察组术后局部血清肿发生率(1.96%)低于对照组(15%),差异有统计学意义(P<0.05);两组术后复发率比较,差异无统计学意义(P>0.05)。结论相对于TEP术,双腹腔镜TEP术可降低术后血清肿发生率,提高对侧隐匿性疝检出率,并能探查到嵌顿疝内容物。

Objective To explore the application value oftotally extraperitoneal prosthesis(TEP)with two laparoscopes in the treatment of inguinal hernia.Methods From August 2016 to June 2018,the clinical data of 91 cases with inguinal hernias in Department of Minimally Invasive Surgery of the First People’s Hospital of Hefei were retrospectively analyzed.According to the operative methods,the patients were divided into two groups.The observation group(51cases)received TEP with two laparoscopes,while the control group(40cases)received TEP.The general situation of operation(operation time,postoperative hospital stay,intraoperative detection of the contralateral concealed hernia,intraoperative exploration of the contents of incarcerated hernia),the incidence rates of postoperative seroma and recurrence were recorded and compared between the two groups.Results The average operation time and postoperative hospital stay in observation group were(59.76±11.63)min and(4.23±1.05)d,those in control group were(57.45±11.03)min and(4.22±1.27)d,and there were no significant differences between the two groups(P>0.05).There were 7 cases detected contralateral hidden hernia,and 12 cases detected the contents of incarcerated hernia inobservation group during operation,which were better than those in control group(0 case,0 case),the differences between the two groups were significant(P<0.05).The incidence rate of postoperative seroma in observation group was 1.96%,which was lower than 15%in control group,and the difference between the two groups was statistically significant(P<0.05).There was no significant difference in thepostoperative recurrence between the two groups(P>0.05).Conclusion Compared with TEP,TEP with two laparoscopes can decrease the incidence rate of postoperative seroma,increase the detective rate of contralateral concealed hernia,and explore the contents of incarcerated hernia during operation,which is worthclinical promotion.