纵向腹膜切开法在经腹腹膜前无张力疝修补术中的应用

Application of longitudinal peritoneal incision in the tension-free transabdominal preperitoneal hernia repair

目的:通过比较纵向与横向法切开腹膜在经腹腹膜前无张力疝修补术(TAPP)中的手术效果,探讨纵向切开腹膜法的应用价值。方法:采用前瞻性研究方法,将2020年11月至2022年7月62例腹股沟疝、股疝患者按手术顺序单侧依次分入纵向切开组(纵切组)与横向切开组(横切组),对比分析两组手术时间、分离腹膜前间隙时间、放置补片时间、缝合腹膜时间、精索输精管损伤率及术后血清肿发生率、复发率。结果:纵切组与横切组手术时间[(71.24±20.11)min vs.(70.97±25.81)min,P>0.05]、放置补片时间[(13.58±4.49)min vs.(13.09±4.33)min,P>0.05]差异无统计学意义,分离腹膜前间隙时间[(34.42±11.36)min vs.(26.13±11.82)min,P<0.05]、缝合腹膜时间[(14.48±5.19)min vs.(22.72±8.27)min,P<0.05]差异有统计学意义,纵切组精索输精管损伤率低于横切组,差异有统计学意义(P=0.027),两组术后血清肿发生率差异无统计学意义(P>0.05)。术后两组均无复发。结论:纵向腹膜切开法可较好地显露精索、输精管,减少精索与输精管的损伤,简化腹膜缝合流程,缩短缝合时间,是TAPP术中较好的腹膜切开方式,值得推广。

Objective:To investigate the application value of longitudinal peritoneotomy by comparing the surgical effect of transverse and longitudinal peritoneal incision in transabdominal preperitoneal(TAPP)tension-free hernia repair.Methods:The p rospective study method was used,62 patients with inguinal hernia of femoral hernia from Nov.2020 to Jul.2022 were divided into l ongitudinal incision group and transverse incision group in turn according to the sequence of operation.The average operation time,time of preperitoneal space separation,time of mesh placement,time of peritoneum suturation,injury rate of spermatic cord and vas deferens,incidence of postoperative seroma and recurrence rate between two groups were compared.Results:There were no statistically significant differences between longitudinal incision group and transverse incision group in operation time[(71.24±20.11)min vs.(70.97±25.81)min,P>0.05],the time of mesh placement[(13.58±4.49)min vs.(13.09±4.33)min,P>0.05],there were statistically significant differences in time of preperitoneal space separation[(34.42±11.36)min vs.(26.13±11.82)min,P<0.05]and the time of peritoneum suturation[(14.48±5.19)min vs.(22.72±8.27)min,P<0.05].The injury rate of spermatic cord and vas deferens in longitudinal incision group was significantly lower than that of transverse incision group(P=0.027).The incidence of postoperative s eroma was not significantly different between the two groups(P>0.05),there was no recurrence in both groups.Conclusions:The method of longitudinal peritoneotomy can expose the spermatic cord and vas deferens easily,decrease injury of spermatic duct and vas deferens,simplify the peritoneal suture process and reduce the suture time.It is a good supplementary method in TAPP and worth popularizing.