改良补片缝合固定法在腹腔镜经腹腹膜前疝修补术中的应用

Application of modified patch suture fixation in laparoscopic transabdominal preperitoneal hernia repair

目的:探讨改良补片缝合固定法在腹腔镜经腹腹膜前疝修补术中的应用价值。方法:选择2018年1月至2021年1月收治的213例腹股沟疝男性患者,将其分为实验组(n=108)与对照组(n=105);两组均行腹腔镜经腹腹膜前疝修补术,采用聚丙烯补片,其中实验组将补片缝合固定于前腹壁,对照组补片放置后不进行缝合固定。对比分析两组手术时间、术中出血量、术后住院时间、治疗费用、术后补片移位、复发及并发症。结果:实验组手术时间长于对照组(P<0.05),两组术中出血量、术后住院时间、治疗费用差异无统计学意义(P>0.05)。实验组术后无补片移位,复发1例,复发率为0.93%;对照组术后补片移位6例(5.71%),复发8例(7.62%);实验组术后补片移位发生率、复发率均低于对照组(P<0.05)。实验组与对照组术后并发症发生率差异无统计学意义(5.56%vs.4.76%,P>0.05)。结论:腹腔镜经腹腹膜前疝修补术中应用改良补片缝合固定法安全性较高,不会增加并发症发生风险,可有效避免补片移位,减少术后复发,但可能增加手术时间,对术者镜下缝合技术要求高。

Objective:To investigate the clinical value of modified patch suture fixation in the laparoscopic transabdominal preperitoneal prosthesis.Methods:A total of 213 male patients with inguinal hernia admitted from Jan.2018 to Jan.2021 were selected and divided into two groups:experimental group(n=108)and control group(n=105).In the two groups,laparoscopic transabdominal preperitoneal herniorrhaphy was performed using polypropylene patches,the experimental group sutured the patch to the anterior abdominal wall,and the control group did not perform suture fixation after the patch was placed.The operating time,intraoperative blood loss,postoperative hospital stay,treatment costs,postoperative patch displacement,recurrence and complications were compared between the two groups.Results:The operative time of the experimental group was significantly longer than that of the control group(P<0.05).There was no significant difference in the amount of bleeding,postoperative hospital stay and medical cost(P>0.05).In the experimental group,there was no patch shift after surgery,and only 1 case of recurrence happened,the recurrence rate was 0.93%.In the control group,the patch shift occurred in 6 patients(5.71%),and the recurrence was found in 8 patients(7.62%).The recurrence rate and the incidence of patch displacement in the control group were higher than those in the experimental group(P<0.05).However,there was no significant difference in postoperative complications between the two groups(5.56%vs.4.76%,P>0.05).Conclusions:The modified patch suture fixation method is safe for laparoscopic transabdominal preperitoneal prosthesis.It can not only decrease the risk of complications and patch displacement,but also reduce postoperative recurrence.Nevertheless,the method requires longer operation time and better surgical suture techniques.