自固定补片在Ⅲ型腹股沟疝TEP术中的临床应用分析

Analysis of the Clinical Application of Self-fixation Mesh inⅢType Inguinal Hernia TEP

目的总结腹腔镜完全腹膜外修补(TEP)术中应用自固定补片治疗Ⅲ型腹股沟疝的经验,探讨其安全性和可行性。方法回顾性对比研究2017年1月至2020年1月期间徐州医科大学附属宿迁医院普外科60例Ⅲ型腹股沟疝TEP术中采用自固定补片的临床资料。根据手术方式不同分两组,观察组30例:TEP术中内环口以远1~2 cm横断疝囊、远端旷置,2-0倒刺线将扩大的内环口连续缝合缩窄,自固定补片覆盖患侧肌耻骨孔;对照组30例:TEP术中完全剥除回纳疝囊,自固定补片覆盖患侧肌耻骨孔。观察围手术期及术后随访情况。结果①手术情况:两组手术时间(96.20±24.80)min vs.(123.60±30.30)min,t'=4.033,P=0.000;术中出血量(6.70±3.80)mL vs.(9.10±4.40)mL,t=2.295,P<0.026;疝囊破裂2例vs.6例,χ^(2)=2.306,P=0.254;中转TAPP 0 vs.2例,χ^(2)=2.067,P=0.500。②术后情况:两组患者均顺利康复出院,两组患者术后下床活动时间(7.40±2.50)h vs.(13.90±5.70)h,t'=4.303,P=0.000;术后住院时间(2.40±0.60)d vs.(4.50±1.10)d,t'=4.256,P=0.000;术后血清肿0 vs.5例,χ^(2)=2.204,P=0.052;术后疝膨出0 vs 1例,P=1.000。③随访情况:门诊或微信电话随访12个月,两组患者均无慢性疼痛、疝复发、补片排斥、感染病例。结论TEP术中采用自固定补片治疗Ⅲ型腹股沟疝安全可行,合理处理疝囊、选择性缝合扩大的内环口有利于减少术后并发症,值得临床推广。

Objective To summarize the experience of treatingⅢtype inguinal hernia with self-fixation mesh during laparoscopic complete extraperitoneal repair(TEP),and to investigate its safety and feasibility.Methods The clinical data of 60 cases ofⅢtype inguinal hernia with self-fixation mesh in the general surgery department of Suqian Hospital Affiliated to Xuzhou Medical University from January 2017 to January 2020 were retrospectively compared.According to different surgical methods,the patients were divided into two groups:observation group(n=30):the hernia sac was cut off 1-2 cm away from the internal ring during TEP operation,and the distal end was open.The enlarged internal ring was continuously sutured and narrowed with 2-0 barb thread,and the self-fixation patch covered the muscle pubic foramina of the affected side.In the control group(n=30),the hernia sac was completely removed and the pubis foramen of the affected side was covered with self-fixation mesh during TEP.The perioperative period and postoperative follow-up were observed.Results(1)Operation conditions:operation time in the two groups was(96.20±24.80)min vs.(123.60±30.30)min,t'=4.033,P=0.000;intraoperative blood loss was(6.70±3.80)mL vs.(9.10±4.40)mL,t=2.295,P<0.026;2 cases vs.6 cases of hernia sac rupture,χ^(2)=2.306,P=0.254;TAPP 0 vs.2 cases of transferred(χ^(2)=2.067,P=0.500).(2)Postoperative conditions:patients in both groups recovered and were discharged smoothly.Postoperative activity time of patients in both groups was(7.40±2.50)h vs.(13.90±5.70)h,t'=4.303,P=0.000;postoperative hospitalization time(2.40±0.60)d vs.(4.50±1.10)d,t'=4.256,P=0.000;5 cases of postoperative seroma,χ^(2)=2.204,P=0.052;postoperative herniocele was 0 vs.1 case(P=1.000).(3)Follow-up:Outpatient or WeChat telephone follow-up was conducted for 12 months,and there were no cases of chronic pain,hernia recurrence,patch rejection or infection in both groups.Conclusion The treatment ofⅢtype inguinal hernia with self-fixation mesh in TEP is safe and feasible.Reasonable management of hernia sac and selective suture of enlarged internal ring are beneficial to reduce postoperative complications,which is worthy of clinical promotion.