MiniLap辅助两穿刺孔腹腔镜全腹膜外腹股沟疝修补术10例分析

MiniLap-assisted double ports laparoscopic totally extraperitoneal inguinal hernia repair:Analysis of 10 cases

目的介绍使用MiniLap辅助两穿刺孔腹腔镜全腹膜外腹股沟疝修补术(MaDP TEP)的临床优势。方法回顾性分析2022年6—10月于中山大学附属第七医院消化医学中心疝与腹壁外科专业组行MaDP TEP 10例患者的临床资料。10 mm腹腔镜穿刺孔、5 mm操作穿刺孔、MiniLap参考全腹膜外腹股沟疝修补术(TEP)三穿刺孔中侧法布局。使用MiniLap无需做线性切口,经1 mm皮肤开口即可穿刺置入术区。分析患者一般资料,记录术后第1天疼痛数字评定量表(NRS)评分、手术部位感染率、疝复发率、术后3周两穿刺孔和MiniLap处瘢痕SCAR评分、单侧疝分离操作时间(即除外放置补片的手术时间)。结果10例患者中,男性9例,女性1例;年龄45~70岁,平均52.3岁;包含Rutkow(改良Gilbert分型)Ⅰ、Ⅱ、Ⅲ、Ⅴ、Ⅵ型。10例患者均成功实施MaDP TEP,术中无血管损伤,无中转开放手术。术后第1天疼痛NRS评分(1.50±0.53)分。随访1~19周,无手术部位感染,无疝复发。术后3周10 mm穿刺孔、5 mm穿刺孔和MiniLap处瘢痕SCAR评分分别为(5.10±1.25)分、(3.75±0.79)分和(1.80±0.70)分,瘢痕评分比较差异有统计学意义(P<0.01)。10例手术单侧疝分离操作时间:第1~5例(47.8±12.0)min,第6~10例患者(30.8±5.3)min,差异有统计学意义(P=0.02)。结论MaDP TEP安全有效,疼痛轻、美容减创效果好,与三穿刺孔TEP技术接近,学习曲线短,便于临床推广。

Objective To introduce the clinical advantages of MiniLap assisted double ports laparoscopic totally extraperitoneal inguinal hernia repair(MaDP TEP).Methods A retrospective analysis of the clinical data of 10 patients who underwent MaDP TEP from June to October 2022 at the Hernia and Abdominal Wall Surgery Unit of the Center for Digestive Disease,the Seventh Affiliated Hospital of Sun Yat-sen University were performed.The procedure involved a 10mm laparoscopic trocar,a 5mm working trocar,and the MiniLap,referring to the layout of the traditional three-trocar totally extraperitoneal inguinal hernia repair(TEP).The MiniLap was inserted into the operative area through a 1mm skin incision without the need for a linear incision.The general data of the patients were analyzed,and postoperative outcomes were recorded,including day 1 postoperative Numerical Rating Scale(NRS)pain scores,infection rates at the surgical site,hernia recurrence rates,3-week scar scores at the two trocar sites and the MiniLap site using the SCAR scale,and unilateral hernia dissection operation time(excluding the time for mesh placement).Results Among the 10 patients,there were 9 males and 1 female;ages ranged from 45 to 70 years,with an average of 52.3 years;including Rutkow types(modified Gilbert types)I,II,III,V,and VI.All 10 patients successfully underwent MaDP TEP without vascular injury or conversion to open surgery.The postoperative day 1 pain NRS score was 1.50±0.53.During a follow-up of 1-19 weeks,there were no surgical site infections or hernia recurrences.At 3 weeks postoperatively,the SCAR scores for the 10 mm trocar site,the 5mm trocar site,and the MiniLap site were(5.10±1.25),(3.75±0.79),and(1.80±0.70)respectively,showing statistically significant differences(P<0.01).The unilateral hernia dissection operation time for the first 5 cases was(47.8±12.0)minutes and for the last 5 cases was(30.8±5.3)minutes,with a statistically significant difference(P=0.02).Conclusion MaDP TEP is safe and effective,offering minimal pain,excellent cosmetic results,and comparable performance to the traditional three-trocar TEP technique.With a short learning curve,it is suitable for widespread clinical adoption.