后鞘后入路在单孔腹腔镜全腹膜外腹股沟疝修补术中的应用体会(附61例报告)

Application of posterior sheath approach in single-incision laparoscopic totally extraperitoneal inguinal hernia repair:with a report of 61 cases

目的:总结后鞘后入路在单孔腹腔镜完全腹膜外腹股沟疝修补术中的应用特点、独特视野下的解剖发现与手术技巧。方法:回顾分析2020年1月至2020年6月施行的61例后鞘后入路经脐单孔腹腔镜全腹膜外腹股沟疝修补术患者的临床资料。结果:手术时间单侧平均(53.37±19.96)min,术中出血量平均(5.31±4.96)mL。术中出现腹膜破损10例。术后第1天疼痛视觉模拟评分平均(2.30±1.19)分,第3天平均(0.27±0.44)分。术后发生脐部切口感染1例、皮下淤血1例,随访未发现慢性疼痛、补片感染及复发。结论:后鞘后入路经脐单孔腹腔镜完全腹膜外腹股沟疝修补术安全、可行,对于双侧疝更具价值,其独特视野为腹腔镜下腹股沟区解剖提供了新的研究方向。

Objective:To summarize the application characteristics,the anatomic findings and surgical skills under the unique vision of posterior sheath approach in single incision laparoscopic totally extraperitoneal inguinal hernia repair.Methods:The clinical data of 61 cases of single incision laparoscopic totally extraperitoneal inguinal hernia repair by posterior sheath approach from Jan.2020 to Jun.2020 were retrospectively analyzed.Results:The operation time was(53.37±19.96)min on one side and the bleeding volume was(5.31±4.96)mL.The peritoneum injury occurred in 10 patients.Pain visual analogue score was(2.30±1.19)on the first day and(0.27±0.44)on the third day after surgery.Postoperative complications included umbilical incision infection(n=1)and ecchymosis(n=1).During the follow-up,no chronic pain,patch infection or recurrence was found.Conclusions:Transumbilical single incision laparoscopic totally extraperitoneal inguinal hernia repair via posterior sheath approach is safe and feasible.It is more valuable for bilateral hernia and its unique vision provides a new research direction for the laparoscopic anatomy of the inguinal area.