手术解剖层面转换在腹腔镜完全腹膜外腹股沟疝修补术中的应用体会:附视频

Experiences in applying surgical anatomical plane conversion in laparoscopic totally extraperitoneal inguinal hernia repair:video attached

目的采用手术解剖层面转换概念,简化腹腔镜完全腹膜外腹股沟疝修补术(TEP),并评估其安全性和可靠性。方法使用腹直肌后入路完全腹膜外腹膜前修补120例(128侧)腹股沟疝患者。主要的手术技术包括通过分离腹直肌和后鞘之间的腹直肌后间隙,建立第一个平面;在弓形线下方做一个横向切口,从该切口进入腹横筋膜和腹膜前筋膜之间的第二个平面(Retzius间隙),完成第一次转换;然后通过切开间隙韧带进入腹膜前筋膜和腹膜之间的第三个平面(Bogros间隙),完成第二次转换;最后创造一个宽敞的腹膜前间隙以容纳补片。同时评估患者的年龄、性别、疝类型、手术时间、住院时间、并发症、疼痛和复发情况。结果右侧疝64例,左侧疝48例,双侧疝8例(16侧);斜疝67例,直疝44例,复杂疝8例,股疝1例。单侧疝平均手术时间为(55±2.3)min,双侧疝手术时间范围为45~130 min,平均(100±1.5)min。术后并发症发生率7.5%(9/120),但没有发生严重并发症。住院时间为5~11 d,平均(7±0.8)d。随访时间为6~84个月,平均(63±5.3)个月,未发现慢性疼痛和复发病例。结论手术解剖层面转换技术在TEP中简单易学、安全有效可靠。

Objective To simplify the totally extraperitoneal inguinal hernia repair(TEP)by surgical anatomic conversion,and to explore its safety and reliability.Methods One hundred and twenty-eight inguinal hernias were treated in 120 patients,using a retromuscular approach for totally extraperitoneal repair.The primary surgical technique involved the dissection of the retromuscular space between the rectus abdominis muscle and its sheath,establishing the first plane.A transverse incision was made below the arcuate line to facilitate the first conversion,allowing access the second plane between the transversalis fascia and the preperitoneal fascia(Retzius space).Subsequently,the ligamentous structures were dissected,allowing for the second conversion to enter the third plane between the preperitoneal fascia and the peritoneum(Bogros space).A spacious preperitoneal space was created to accommodate the mesh.Patients were assessed for age,sex,type of hernias,operation time,hospital stay,complications,and recurrence.Results There were 64 cases on the right side,48 cases on the left side,and 8 cases of bilateral hernia(16 sides).Among them,there were 67 cases of indirect hernias,44 cases of direct hernias,8 cases of complex hernia(12 sides),and 1 case of femoral hernia.The average surgical time for unilateral hernias was(55±2.3)minutes,while(100±1.5)minutes for bilateral hernias(range:45-130 minutes).The incidence of postoperative complications was 9 cases(7.5%),but there were no severe complications.The hospital stay ranged from 5 to 11 days,with an average of(7±0.8)days.The follow-up period ranged from 6 to 84 months,with an average of(63±5.3)months.No cases of chronic pain or recurrence were observed.Conclusion The application of the surgical anatomic plane conversion in TEP is easy to learn,safe,effective and reliable.