后鞘后单孔腹腔镜腹股沟疝修补术中完全可视化建腔技术的应用

The application of completely visualized cavity construction technique in posterior sheath single incision inguinal hernia repair

目的:总结完全可视化建腔技术应用于后鞘后入路单孔腹腔镜腹股沟疝完全腹膜外修补术(single incision laparoscopic totally extraperitoneal hernia repair,SIL-TEP)的初步经验和操作要点。方法:回顾性分析2023年1月至2023年4月施行的30例经脐后鞘后入路SIL-TEP患者的临床资料。结果:术中建腔时发生腹膜破损1例(3.3%),术中出血量(9.50±2.40) ml。手术时间单侧平均(61.04±15.11) min,双侧平均(80.83±16.25) min。切皮到装置置入时间平均(120.77±17.16)s,进入鞘后空间时间平均(249.67±66.71)s。术后24 h疼痛视觉模拟评分平均(2.57±0.73)分,48 h平均(1.97±0.56)分。术后脐部切口感染1例(3.3%),尿潴留1例(3.3%),血清肿3例(10%),皮下瘀血1例(3.3%),术后随访均未发现慢性疼痛、补片感染及疝复发。结论:完全可视化建腔技术视野清晰,解剖层次明确,腹膜破损率低,有效降低手术难度,可常规应用于后鞘后SIL-TEP。

Objective To summarize the preliminary experience and key points of the application of completely visualized cavity construction technique in the posterior sheath approach single incision laparoscopic totally extraperitoneal hernia repair(SIL-TEP).Methods Retrospective analysis of the clinical data of 30 cases of posterior sheath approach SIL-TEP from Jan.2023 to Apr.2023.Results The peritoneum injury occurred in 1 patient(3.3%)when establishing the cavity.The bleeding volume was(9.50±2.40)ml.The operation time was(61.04±15.11)min on one side and(80.83±16.25)min on two sides.The time from skin cutting to device insertion was(120.77±17.16)sec.The time to enter the space behind the posterior sheath was(249.67±66.71)sec.The postoperative pain visual analogue score was(2.57±0.73)at 24 hours and(1.97±0.56)at 48 hours.Postoperative umbilical incision infection occurred in 1 patient(3.3%),Urinary retention in 1 patient(3.3%),seroma in 3 patients(10%),and ecchymosis in 1 patient(3.3%).No Chronic pain,patch infection,or recurrence was found in the follow-up.Conclusions The completely visualized cavity construction technology has a clear field of vision,clear anatomical hierarchy,low peritoneum injury rate,and effectively reduces surgical difficulty.It can be routinely applied to the posterior sheath SIL-TEP.