3D补片预选择在腹腔镜完全腹膜外腹股沟疝修补术中的应用

Application of 3D mesh preselection in laparoscopic totally extraperitoneal inguinal hernia repair

目的:探讨腹腔镜完全腹膜外疝修补术前预先准确选择合适的3D补片治疗腹股沟疝的安全性及临床疗效。方法:选取2020年5月至10月收治的35例(38侧)腹股沟疝患者,均行腹腔镜完全腹膜外疝修补术,术前通过拍摄骨盆正位片,测量髂前上棘内下缘至耻骨联合中点的直线距离,体表标记测量的内环直径,通过测量数值评估选择适宜的3D补片,4例为13.4 cm×7.9 cm大,22例为15.7 cm×10.3 cm,9例为17.0 cm×12.2 cm。记录术前测量数值、手术时间、术中出血量、术后疼痛评分及并发症发生情况。结果:手术时间平均(51.6±10.8)min,术中出血量(3.3±0.8)mL,术后疼痛视觉模拟评分<3分,术后发生血清肿3例(8.57%),均通过湿敷硫酸镁吸收。患者随访均超过1年,无复发、感染、补片排异及慢性疼痛等并发症发生。结论:根据术前测量的相关数值预先选择3D补片,在腹腔镜完全腹膜外疝修补术中是安全、可行的,为腹股沟疝的个体化、精准化治疗提供了新思路。

Objective:To investigate the safety and clinical efficacy of accurate preselection of suitable 3D patch before laparoscopic totally extraperitoneal prosthesis(TEP)in the treatment of inguinal hernia.Methods:Thirty-five patients(38 sides)with inguinal hernia from May 2020 to Oct.2020 were selected.The patients were treated by laparoscopic TEP.Before the operation,the straight-line distance from the inner inferior edge of the anterior superior iliac spine to the midpoint of the pubic symphysis was measured by taking the pelvic anterior film,and the measured inner ring diameter was marked on the body surface.Appropriately sized 3D patches were selected by numerical evaluation,including 4 cases of 13.4 cm×7.9 cm patches,22 cases of 15.7 cm×10.3 cm patches,and 9 cases of 17.0 cm×12.2 cm patches.Preoperative measurement values,operation time,intraoperative blood loss,postoperative pain score and complications were recorded.Results:The operation time was(51.6±10.8)min,the intraoperative blood loss was(3.3±0.8)mL,the postoperative pain visual analogue scale was less than 3 points.3 cases(8.57%)of postoperative seroma occurred,all were absorbed by wet compress of magnesium sulfate.All patients were followed up for more than 1 year without complications such as recurrence,infection,patch rejection and chronic pain.Conclusions:According to the relevant values measured before operation,preselection of 3D patches is safe and feasible in laparoscopic TEP treatment of inguinal hernia,it provides a new idea for individualized and precise treatment of inguinal hernia patients.