腹膜外间隙空间的建立与细分在腹腔镜全腹膜外疝修补术中的应用研究

Clinical investigation of the establishment and subdivision of extraperitoneal space in total extraperitoneal herniorrhaphy

目的探讨腹膜外间隙空间建立与细分的程序化“四空间”技术在腹腔镜全腹膜外疝修补术(TEP)中的意义。方法选取2017年7月至2019年11月120例行TEP的成人男性腹股沟斜疝患者按照术式不同随机分为四空间组、传统组各60例。采用SPSS 20.0软件进行统计学分析,两组围术期各项指标等计量资料以(x±s)表示,采用独立t检验。术后并发症等计数资料采用χ^2检验;以P<0.05为差异有统计学意义。结果两组均顺利完成手术,无中转行开放疝修补手术。四空间组术后住院时间、手术时间、术中出血量均少于传统组(P<0.05);四空间组腹膜破损、血清肿、腹壁下动脉损伤、术后慢性疼痛的发生率均低于传统组(P<0.05),两组患者创面感染、疝复发的发生率比较,差异无统计学意义(P>0.05)。结论在TEP中,应用程序化“四空间”技术建立与细分腹膜外间隙空间,可以提高手术质量及安全性,减少手术并发症,值得推广。

Objective To explore the clinical significance of the programmed"four-space"technique for the establishment and subdivision of extraperitoneal space in laparoscopic Total Extraperitoneal(TEP)Herniorrhaphy.Methods A total of 120 adult male patients with oblique inguinal hernia underwent TEP from July 2017 to November 2019 were randomized into four-space group(60 cases)and traditional group(60 cases),according to different surgical procedures.The SPSS 20.0 software were used for statistical analysis.The count data such as perioperative indicators in the two groups were expressed as (x±s),and were examined by using the independent t test.Count data such as postoperative complications were tested by usingχ^2;A P value of<0.05 was considered as statistically significant difference.Results The operation was completed successfully in both groups,and there was no case of conversion to open herniorrhaphy.The postoperative hospital stay,operation time and intraoperative bleeding in the four-space group were shorter or lower than those in the traditional group respectively(P<0.05).The incidence of peritoneal rupture,seroma,inferior epigastric artery injury and postoperative chronic pain in the four-space group was lower than those in the traditional group respectively(P<0.05).There was no significant difference between the two groups in terms of the incidence of wound infection and hernia recurrence(P>0.05).Conclusion In TEP group,establishment and subdivision of the extraperitoneal space by using the programmed"four-space"technique could improve the quality and safety of surgery,could reduce surgical complications,and is worthy of promotion.