改良缝合法处理疝环缺损在腹腔镜经腹膜前腹股沟直疝修补术中的应用

Application of modifi ed suture method in treating hernia ring defect in laparoscopic transabdominal preperitoneal hernia repair for direct inguinal hernia

目的探讨腹腔镜经腹膜前腹股沟直疝修补术关闭疝环缺损的手术流程和预防术后血清肿的临床疗效。方法收集2019年1月至2022年7月安徽医科大学附属合肥医院行腹腔镜经腹膜前疝修补术的80例腹股沟直疝患者资料,根据对疝环缺损的不同处理方式分为研究组(40例)和对照组(40例)。研究组术中用3-0倒刺缝线5针法缝合疝环缺损,“十”字法贯穿缝合假疝囊;对照组术中旷置假疝囊。记录两组手术时间、住院时间、住院费用以及术后血清肿等并发症的发生情况。结果所有患者均顺利完成手术。研究组的手术时间长于对照组(t=5.291,P<0.001),两组间住院费用及术后住院时间差异无统计学意义(t=1.947、-0.493,P=0.055、0.623);研究组术后血清肿的发生率明显低于对照组,差异有统计学意义(5.0%vs 22.5%,χ2=5.165,P=0.023)。结论腹腔镜经腹膜前腹股沟直疝修补术中采用倒刺线改良缝合关闭疝环缺损的方法操作简便且安全,能够有效预防血清肿的发生。

Objective To explore the clinical utility of hernia defect closure in the laparoscopic transabdominal preperitoneal hernia repair(TAPP)for direct inguinal hernia for the prevention of postoperative seroma formation.Methods From January 2019 to July 2022,a total of 80 patients undergoing TAPP were selected in Heifei Hospital Affiliated to Anhui Medical University.According to different treatment of hernia defect closure,the patients were divided into trial group(40 cases)and control group(40 cases).The trial group was applied with hernia defect closure(closed and fi xed transverse fascia with reverse thorn suture,and“cross”mattress suture of the transverse fascia),while the control group did not close the defect.In the two groups,operation duration,length of stay,hospitality and postoperative seroma were recorded.Results The operation was successfully completed in all cases.The operation duration in the trial group was longer than the control group(t=5.291,P<0.001).There were no signifi cant differences in hospitalization costs and postoperative hospitalization duration between the two groups(t=1.947,-0.493,P=0.055,0.623).The postoperative seroma in the trial group was signifi cantly less than the control group(5.0%vs 22.5%,χ2=5.165,P=0.023).Conclusion In laparoscopic TAPP,modified suture with reverse thorn suture to close the hernia defect is safe and effective,and can effectively prevent the occurrence of seroma.