腹腔镜下经腹壁穿刺固定法处理直疝假疝囊的应用分析

Application Analysis of Laparoscopic Transabdominal Wall Puncture Fixation Method for the Management of False Hernia Sac in Direct Hernia

目的探讨腹腔镜下经腹壁穿刺固定法处理腹股沟直疝假性疝囊的临床疗效性及价值性。方法回顾性选取2021年1月—2022年6月漳浦县医院普外科收治的130例腹股沟直疝患者的临床资料,手术方式为腹腔镜完全腹膜外疝修补术或腹腔镜经腹膜前疝修补术,根据直疝假疝囊固定方式分为对照组(采用医用胶固定,n=65)和观察组(经腹壁穿刺固定法采用腹壁缝合钳在腹腔镜下经腹壁穿刺固定,n=65)。比较两组患者手术操作时间、疝囊关闭时间、穿刺出血、住院时间及术后并发症等。结果观察组手术操作时间、疝囊关闭时间、穿刺出血量及住院时间均优于对照组,差异有统计学意义(P均<0.05)。观察组术后穿刺点感染、术后血清肿、异物牵拉感、区域疼痛、麻痹感总发生率为3.08%低于对照组的15.38%,差异有统计学意义(χ^(2)=4.499,P<0.05)。结论在直疝假性疝囊处理方式中,腹腔镜下经腹壁穿刺固定法是一种微创、便捷、有效、安全、经济的技术,很好降低术后血清肿、感染等并发症发生率。

Objective To explore the clinical efficacy and value of laparoscopic transabdominal wall puncture fixation in the management of false hernia sac of inguinal direct hernia.Methods The clinical data of 130 patients with direct inguinal hernia admitted to the General Surgery Department of Zhangpu County Hospital from January 2021 to June 2022 were retrospectively selected.The surgical methods were laparoscopic complete extraperitoneal hernia repair or laparoscopic preperitoneal hernia repair.The patients were divided into the control group according to the fixation methods of the false hernia sac of direct hernia(fixed by medical glue,fixed by peritoneal hernia,n=65)and observa⁃tion group(transabdominal wall puncture fixation with abdominal wall suture forceps under laparoscopy,n=65).Opera⁃tion time,hernia sac closing time,puncture bleeding,hospital stay and postoperative complications were compared be⁃tween the two groups.Results Operation time,hernia sac closing time,puncture blood loss and hospital stay in obser⁃vation group were better than those in control group,and the differences were statistically significant(all P<0.05).The total incidence of puncture site infection,postoperative seroma,foreign body tug,regional pain and paralysis in the ob⁃servation group was 3.08%,which was lower than 15.38%in the control group,and the difference was statistically sig⁃nificant(χ^(2)=4.499,P<0.05).Conclusion In the treatment of false hernia sac,laparoscopic transabdominal fixation is a minimally invasive,convenient,effective,safe and economical technique,which can well reduce postoperative complications such as seroma and infection.