后鞘后经脐缘单孔腹腔镜完全腹膜外腹股沟疝修补术:500例回顾性分析

Single incision laparoscopic totally extraperitoneal inguinal hernia repair by posterior sheath approach:a retrospective analysis of 500 cases

目的探讨后鞘后入路,经脐缘单孔腹腔镜完全腹膜外腹股沟疝修补术(single incision laparoscopic totally extraperitoneal hernia repair,SIL-TEP)的安全性、有效性,以及术后生活质量和满意度。方法回顾性分析2019年12月—2021年12月在4家医院施行的后鞘后入路SIL-TEP患者的临床资料,分别采用卡罗莱纳舒适量表、数值评定量表和手术切口满意测评问卷来评定生活质量、手术满意度和切口美容效果。结果共纳入500例患者,其中男性450例、女性50例,平均手术时间:单侧56.6 min,双侧77.2 min。术中并发症中,腹膜破损150例,精索血管损伤4例,无大血管、输精管、肠管和膀胱损伤,无一例中转为常规腹腔镜手术。术后并发症中,血清肿28例,血肿5例,阴囊水肿19例,尿潴留2例,切口感染3例。术后6、24和48 h平均疼痛视觉模拟评分依次为2.6、1.7和0.6。术后半年生活质量量表中各项平均得分依次为:异物感0.008,疼痛0.016,活动受限0.002;手术满意度5分者479例,美容满意度平均9.9。平均随访13.9个月,期间疝复发3例,无切口疝和补片感染。结论后鞘后经脐缘SILTEP安全可行,而且在术后疼痛、生活质量和手术瘢痕等方面能够达到令人满意的效果。

Objective To investigate the safety,effectiveness,post-operative quality of life and satisfaction of trans-umbilical single incision laparoscopic totally extraperitoneal hernia repair(SIL-TEP)by posterior sheath approach.Methods Clinical data of patients undergoing SIL-TEP by posterior sheath approach in four hospitals from Dec 2019 to Dec 2021 were retrospectively analyzed.The quality of life,surgical satisfaction and cosmetic effect of incision were respectively evaluated by Carolina Comfort Scale,Numerical Rating Scale and“score of access-site satisfaction and consideration”questionnaire.Results A total of 500 patients were enrolled,including 450 males and 50 females.The mean operation time was 56.6 min for unilateral patients and 77.2 min for bilateral patients.There were 150 cases of peritoneum damage,4 cases of spermatic cord vascular injury,no injury of great vessels,vas deferens,bowel and bladder,and no conversion to conventional laparoscopic surgery.Postoperative complications consisted of inguinal seroma(n=28),hematoma(n=5),scrotal edema(n=19),urinary retention(n=2)and wound infection(n=3).The mean visual analog scores of pains at 6,24 and 48 hours postoperatively were 2.6,1.7 and 0.6,respectively.Six months after the operation,the average scores of all items in the quality of life scale were as follows:mesh sensation 0.008,pain 0.016,movement limitation 0.002.Surgical satisfaction was 5 in 479 cases,and the average cosmetic satisfaction was 9.9.During the mean follow-up of 13.9 months,only 3 patients had recurrent hernia,and no incisional hernia or mesh infection happened in these cases.Conclusion SIL-TEP by posterior sheath approach is safe and feasible,and can achieve satisfactory results in postoperative pain,quality of life and surgical scar.