3D高清腹腔镜在经腹腹膜前腹股沟疝修补术中的应用

Three Dimensional High Definition Laparoscopy in Transabdominal Preperitoneal Inguinal Hernia Repair

目的探讨3D高清腹腔镜下行经腹腹膜前腹股沟疝修补术(TAPP)治疗成人原发性单侧腹股沟疝的临床效果。方法选择2021年1月至2022年2月在我院行TAPP术的腹股沟疝患者,按随机数字表法随机分为两组:3D组45例,年龄22~81岁,左侧13例,右侧32例;斜疝37例,直疝3例,股疝3例,单侧直、斜复合疝2例;腹股沟疝分型:Ⅰ型9例,Ⅱ型30例,Ⅲ型6例;均采用3D腹腔镜系统行TAPP术。2D组49例,年龄23~88岁,左侧17例,右侧32例;斜疝42例,直疝3例,股疝2例,单侧直、斜复合疝2例;腹股沟疝分型:Ⅰ型12例,Ⅱ型32例,Ⅲ型5例;均采用2D腹腔镜系统行TAPP术。结果两组患者性别、年龄、疝分型及类型等基线资料比较,差异均无统计学意义(P>0.05)。围手术期相关指标比较,3D组手术时间、补片放置时间、腹膜缝合时间均少于2D组(P<0.05),而两组术中出血量、术后住院时间、住院总费用比较,差异均无统计学意义(P>0.05)。术后3D组出现血清肿2例,切口感染1例,肺部感染2例,2D组出现血清肿2例,切口感染及肺部感染各1例,两组并发症发生率比较无统计学差异(P>0.05)。术后两组患者均未出现尿潴留、感觉神经障碍等并发症。两组术后NRS评分均在4分以下(轻度疼痛),均未予以特殊处理。术后均获随访,随访时间3~16个月,均未出现慢性疼痛及疝复发。结论3D高清腹腔镜行TAPP术是一种非常有价值的辅助工具,有助于改善解剖的可视化和结构的识别,提高操作的精确性,降低精细操作的难度,缩短手术时间,并且在平衡手术图像显示效果及成本上更具临床优势。

Objective To investigate the clinical efficacy of laparoscopic transabdominal preperitoneal inguinal hernia repair(TAPP)in the treatment of primary unilateral inguinal hernia of adult under the display of 3D high-definition laparoscope.Methods A prospective randomized controlled study was carried out in inguinal hernia patients planned to perform TAPP in our hospital from January 2021 to February 2022.A total of 94 patients were enrolled in the study and divided into two groups according to the random number table.45 patients,aged 22 to 81 years,were selected and performed TAPP with 3D laparoscopic system(as 3D group),including 13 of left lateral hernia and 32 of right lateral hernia,and 37 cases of oblique hernia,3 cases of direct hernia,3 cases of femoral hernia and 2 cases of straight-oblique hernia.And the type of inguinal hernia was typeⅠin 9 cases,typeⅡin 30 cases and typeⅢin 6 cases.49 cases,aged 23 to 88 years,were performed TAPP with 2D laparoscopic system(as 2D group),including 17 of left lateral and 32 of right lateral,and 42 of oblique hernia,3 of direct hernia,2 of femoral hernia and 2 of straight-oblique hernia.And the typing of inguinal hernia wasⅠin 12 cases,Ⅱin 32 cases andⅢin 5 cases.Results There was no significant difference in gender,age,classification and type of inguinal hernia between the two groups(P>0.05).All the operation time,patch flattening and fixation time and peritoneal closure and suture time were less in 3D group than those in 2D group(P<0.05),but there was no significant difference in intra-operative blood loss,postoperative hospitalization time and treatment cost between the two groups(P>0.05).Post-operative complication of seroma was found in 2 cases,wound infection in 1 case and lung infection in 2 cases of 3D group,and seroma in 2 cases,wound infection in 1 case and lung infection in 1 case of 2D group,and there was no statistical difference in the incidence of post-operative complication between the two groups(P>0.05).No urinary retention and sensory nerve disturbance was found in both groups after the operation.All patients were followed up for 3 to 16 months without chronic pain and hernia recurrence.Conclusion 3D laparoscopy can play an important role in the process of TAPP due to improve the visualization of anatomy and structure recognition,increase the accuracy of operation,simplify the difficulty of refine operating,shorten the operation time and appear more clinical benefits in balancing the display effect and cost of surgical images.