单孔TEP手术腹直肌后鞘前方与后方入路的对比

施承民; 张同; 吴志忠; 罗华友; 曾玉剑

doi:10.12259/j.issn.2095-610X.S20230522

单孔TEP手术腹直肌后鞘前方与后方入路的对比

doi: 10.12259/j.issn.2095-610X.S20230522

1.
昆明医科大学第一附属医院胃肠外科，云南昆明　650032
2.
普洱市人民医院胃肠及烧伤整形外科，云南普洱　665099

基金项目: 云南省高层次人才培养支持计划“名医专项”基金资助项目（RLMY20200021）

详细信息

作者简介:
施承民（1986～），男，云南昆明人，医学硕士，主治医师，主要从事胃肠道肿瘤及腹部疝疾病的研究工作

通讯作者:
曾玉剑，E-mail：zengyujian@126.com

中图分类号: R656.2
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出版历程
- 收稿日期: 2023-01-24
- 网络出版日期: 2023-05-05
- 刊出日期: 2023-05-25

Comparative Analysis of the Anterior and Posterior Approaches of the Posterior Rectus Sheath in Single-port TEP Surgery

1.
Dept. of Gastrointestinal Surgery，The 1st Affiliated Hospital of Kunming Medical University，Kunming Yunnan 650032
2.
Dept. of Gastrointestinal and Burn Plastic Surgery，People’s Hospital of Pu’er，Pu’er Yunnan 665099，China

摘要

摘要: 目的探索单孔腹腔镜腹股沟疝TEP手术不同入路的优缺点。方法回顾分析昆明医科大学第一附属医院胃肠外科同一手术组2 a内不同入路下单孔腹腔镜完全腹膜外腹股沟疝修补术（single port laparoscopic surgery of totally extraperitoneal，SILS-TEP）手术资料，根据不同手术入路，将65例腹股沟疝患者分为2组：腹直肌后鞘前方入路组和腹直肌后鞘后方入路组，观察术中出血情况，腹膜破损比例，术后1月复查评判有无复发。结果 2种手术入路出血量有明显区别，差异有统计学意义（P = 0.001），术中腹膜破损比例，差异无统计学意义（P = 0.655）。经临床及超声检查双重判断，术后1月均无复发病例。结论 SILS-TEP手术不同入路的选择，在有经验的手术团队开展均是安全可靠的，腹直肌后鞘后方入路出血风险稍大，但影响手术难度的术中腹膜破损率与腹直肌后鞘前方入路无明显区别，通过合理的选择患者，2种入路均可达到满意的临床疗效，初学者仍建议采用腹直肌后鞘前方入路更为合理。
- 单孔 /
- 腹腔镜 /
- 腹股沟疝 /
- 完全腹膜外疝修补术
Abstract: Objective To explore the advantages and disadvantages of different approaches of single-incision laparoscopic surgery for the totally extraperitoneal inguinal hernia repair （SILS-TEP）. Methods The data of single-port laparoscopic total extraperitoneal inguinal hernia repair （SILS-TEP） in the same surgical group of the First Affiliated Hospital of Kunming Medical University were retrospectively analyzed. According to the different surgical approaches, 65 patients with the inguinal hernia were divided into two groups: The anterior approach of rectus abdominis posterior sheath group and the posterior approach of rectus abdominis posterior sheath group. The bleeding during the operation, the proportion of peritoneal damage and the recurrence were observed one month after the operation. Results In this study, it was found that there was a significant difference in bleeding volume between the two surgical approaches, with a statistically significant difference （P = 0.001）. There was no statistically significant difference in the proportion of intraoperative peritoneal damage （P = 0.655）. According to the clinical and ultrasound examinations, there were no recurrent cases within 1 month after the surgery. Conclusion The choice of different approaches for SILS-TEP surgery is safe and reliable in experienced surgical teams.The risk of bleeding in the posterior sheath approach of rectus abdominis is slightly higher, but there is no significant difference between the intraoperative peritoneal damage rate and the anterior sheath approach of rectus abdominis. Through reasonable selection of patients, both approaches can achieve satisfactory clinical effects, and it is still suggested that the posterior rectus abdominis sheath anterior approach be more reasonable for beginners.
- Single-incision /
- Laparoscopic /
- Inguinal hernia /
- Complete external peritoneal hernia repair

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表 1 临床指标比较[n（%）/$ \bar x \pm s $]

Table 1. Comparison of clinical indicators [n（%）/$ \bar x \pm s $]

观察指标	腹直肌后鞘前方入路组（n = 44）	腹直肌后鞘后方入路组（n = 21）	t/χ²	P
出血量（mL）	8.5 ± 4.8	14.0 ± 7.4	4.198	0.001^*
腹膜破损数	3（6.82）	2（9.52）	0.144	0.655
术后复发	0（0.00）	0（0.00）
术后疼痛	2（4.5）	1（4.8）	0.001	1
术后异物感	1（2.3）	1（4.8）	0.291	0.545
^*P < 0.05。

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参考文献(16)

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