提拉Trocar直接穿刺法在腹腔镜完全腹膜外无张力疝修补术中的应用

Application of the direct Trocar puncturein laparoscopic totally extraperitoneal herniorrhaphy

目的探讨腹腔镜完全腹膜外无张力疝修补术(TEP)中第一套管孔建立的方法及其临床应用价值。方法回顾性分析2020年8月—2022年3月本院收治的72例行腹腔镜完全腹膜外无张力疝补术患者的临床资料。按建立第一套管孔方法差异分为观察组(以提拉Trocar直接穿刺法建立第一套管孔)和对照组(Hasson法建立第一套管孔)两组,每组各36例。比较两组建立第一套管孔的时间、美观性、损伤程度、并发症的差异。结果观察组与对照组比较,建立第一套管孔的时间[(60.±6)s vs(156±10)s]差异具有统计学意义(P<0.05);美观性比较,术后半年温哥华瘢痕评价量表(VSS)评分[(3.62.±1.09)分vs(7.95±0.99)分],患者瘢痕自我评分(PSAS)[(11.52.±1.42)分vs(26.14±3.36)分],观测者瘢痕评分(OSAS)[(9.39.±1.43)分vs(18.70±1.71)分],其差异具有显著统计学意义(P<0.001)。损伤程度比较,观察组低于对照组,其差异具有统计学意义(P<0.05)。两组并发症发生情况比较,差异无统计学意义(P>0.05)。结论提拉Trocar直接穿刺法在TEP中建立第一套管孔,具有操作简单、安全快速、有效、美观、损伤小,值得推广。

Objective To explore the method for the establishment of the first trocar pore in total extraperitoneal herniorrhaphy(TEP)and to discuss its clinical application value.Methods The clinical data of 72 patients who underwent laparoscopic total extraperitoneal tension-free herniorrhaphy in our hospital from August 2020 to March 2022 were retrospectively analyzed.According to the different methods of establishing the first casing hole,the two groups were divided into observation group(the first casing hole was established by Trocar direct puncture method)and control group(the first casing hole was established by Hasson method),with 36 cases in each group.The time of establishing the first casing hole,aesthetics,damage degree and complications of the two groups were compared.Results The time of establishing the first casing hole in the two groups were(60.±6)s and(156±10)s,respectively and the difference was statistically significant(P<0.05).Half a year after the surgery,the difference were statistically significant in Vancouver Scar Evaluation Scale(VSS)score[(3.62.±1.09)vs(7.95±0.99)],patient self assess score(PSAS)[(11.52.±1.42)vs(26.14±3.36)],Observer scar assessscore(OSAS)was(9.39.±1.43)vs(18.70±1.71)between the two groups(P<0.001).The injury of Trocar was less than that of Hasson,and the difference was statistically significant(P<0.05).There was no statistical significance in complications between the two groups(P>0.05).Conclusions Trocar direct puncture method has the advantages of simple operation,safe and rapid,effective,beautiful and little damage in establishing the first Trocar hole in TEP.It is worth popularizing.