单孔与三孔腹腔镜全腹膜外单侧腹股沟疝修补术的对比研究

Comparative analysis of single-incision and three-incision laparoscopic totally extraperitoneal unilateral inguinal hernia repair

目的:对比分析单孔腹腔镜完全腹膜外疝修补术(SIL-TEP)与传统三孔完全腹膜外疝修补术(TEP)治疗单侧腹股沟疝的临床效果。方法:回顾分析2021年2月至2023年3月收治的30例单侧腹股沟疝患者的临床资料,按手术方式分为SIL-TEP组与三孔TEP组,每组15例,比较两组手术时间、术中出血量、术中呼气末二氧化碳分压峰值、术后皮下气肿发生率、术后24 h疼痛视觉模拟评分、术后住院时间、切口满意度、术后并发症发生率及复发率等指标。结果:SIL-TEP组手术时间长于三孔TEP组[(105.1±37.7)min vs.(53.3±9.0)min,P<0.01],术中呼气末二氧化碳分压峰值[(45.3±3.4)mmHg vs.(48.1±3.3)mmHg,P<0.05]、术后皮下气肿发生率[6.7%vs.46.7%,P<0.05]、术后24 h疼痛评分[(2.7±0.9)分vs.(3.5±1.0)分,P<0.05]均低于三孔TEP组,切口满意度评分高于三孔TEP组[(9.8±0.4)分vs.(7.7±0.6)分,P<0.01]。两组术中出血量、术后住院时间、术后切口脂肪液化、血清肿发生率差异均无统计学意义(P>0.05),术后随访,两组均无疝复发、慢性疼痛发生。结论:SIL-TEP治疗腹股沟疝安全、可行,虽然手术时间较长,但对术中呼吸功能影响小,具有疼痛轻、美容效果好等优势,具有临床实用价值。

Objective:To comparatively analyze the clinical effect of laparoscopic single-incision totally extraperitoneal(SIL-TEP)and traditional three-incision totally extraperitoneal(TEP)inguinal unilateral hernia repair.Methods:A total of 30 patients with unilateral inguinal hernia from Feb.2021 to Mar.2023 were retrospectively analyzed.According to different surgical approaches,they were divided into SIL-TEP group(n=15)and three-incision TEP group(n=15).The outcomes of both groups were compared,including operative time,intraoperative bleeding volume,intraoperative peak pressure of end-tidal carbon dioxide,postoperative subcutaneous emphysema rate,postoperative 24 h pain visual analogue score,postoperative hospital stay,incision satisfaction rate,postoperative complications and recurrence rate.Results:SIL-TEP group had significantly longer operative time than the three-incision TEP group[(105.1±37.7)min vs.(53.3±9.0)min,P<0.01].Compared to three-incision TEP group,SIL-TEP group showed lower peak pressure of end-tidal carbon dioxide during surgery[(45.3±3.4)mmHg vs.(48.1±3.3)mmHg,P<0.05],the incidence of postoperative subcutaneous emphysema(6.7%vs.46.7%,P<0.05),and postoperative 24 h pain score[(2.7±0.9)vs.(3.5±1.0),P<0.05)].The patients in the SIL-TEP group had significantly higher incision satisfaction scores compared with three-incision group[(9.8±0.4)vs.(7.7±0.6),P<0.01].In addition,there were no statistically significant differences between the two groups in the terms of intraoperative bleeding volume,postoperative hospital stay,incision fat liquefaction and seroma(P>0.05).There was no recurrence and chronic pain existed in either group during the postoperative follow-up period.Conclusions:In the treatment of inguinal hernia,the SIL-TEP is safe and feasible.Although the operative time is longer,SIL-TEP has little effect on intraoperative respiratory function,light postoperative pain,good cosmetic effect,and the value of clinical application.