单孔腹腔镜全腹膜外疝修补术在前列腺癌根治术后腹股沟疝中应用研究

Application of single-incision totally extraperitoneal inguinal hernia repair in inguinal hernia after radical prostatectomy(a report of 30 cases)

目的总结单孔腹腔镜全腹膜外疝修补术(TEP)在前列腺癌根治术后腹股沟疝中的应用。方法回顾性分析2021年1月至2023年1月上海交通大学医学院附属第一人民医院和宁波大学附属第一医院完成的30例前列腺癌根治术后腹股沟疝的单孔腹腔镜TEP资料,对病人病例资料、疝的类型、手术细节和术后情况分别分析。结果病人平均年龄(71.2±8.5)岁,体重指数(BMI)(23.9±1.8)。对19例(63%)病人选择侧方入路。手术切口平均长度(2.5±1.1)cm。中位手术时间74.0(58.5~105.3)min,术中平均出血量(19.2±9.8)mL,1例中转为经腹腹膜前疝修补术(TAPP)。术中腹壁下血管损伤3例(10%),中转TAPP 1例。术后6 h和24 h平均视觉模拟评分(VAS)分别为(2.9±0.8)分和(1.6±0.7)分。平均住院时间(3.6±0.6)d。术后常见并发症为腹股沟区血清肿,共4例(13.3%),无其他相关并发症发生。结论在前列腺癌根治术后腹股沟疝的治疗中应用单孔TEP疗效满意,但需要重视关键要点。

Objective To summarize the application of single-incision laparoscopic totally extraperitoneal inguinal hernia repair(SIL-TEP)after radical prostatectomy(RP).Methods A retrospective study was performed on 30 cases of inguinal hernia repaired by SIL-TEP after RP in the Shanghai General Hospital Affiliated to Shanghai Jiao Tong University School of Medicine and the First Affiliated Hospital of Ningbo University between January 2021 and January 2023.The patient case data,types of hernia,surgical details,and postoperative conditions were analyzed respectively.Results The mean age of patients was(71.2±8.5)years,and BMI was(23.9±1.8).19 cases(63%)of patients were repaired by the lateral approach.The average length of incisions was(2.5±1.1)cm.The mean surgical time was 74.0(58.5~105.3)minutes.The average blood loss was(19.2±9.8)mL,and in 1 case was converted to TAPP,inferior epigastric vessel injury in 3 cases(10%).The mean VAS at 6 h and 24 h were(2.9±0.8)and(1.6±0.7),respectively.The mean hospital length of stay was(3.6±0.6)days.The common postoperative complication was seroma in 4 cases(13.3%),and no other related complication occurred.Conclusion SIL-TEP surgery is effective in the treatment of inguinal hernia after RP,meanwhile,main point should be taken into account.