头侧入路的内镜下全腹膜外疝修补术治疗原发性腹壁疝的临床研究

目的探讨治疗原发性腹壁疝的微创新方法——头侧入路的内镜下全腹膜外疝修补术（TEA）的临床效果。 方法回顾性分析2019年11月至2020年1月，南方医科大学附属何贤纪念医院患者2例，河南中医药大学第一附属医院患者1例，河南省商丘市睢县中医院患者2例，郑州市第七人民医院患者1例，共6例接受头侧入路的TEA手术的原发性脐疝患者的临床资料。阐述手术操作流程及技术细节，分析其可行性和有效性。 结果6例患者术中均成功分离中上腹腹膜外空间并置入大张网片加强修复脐疝缺损，手术均获得成功，无中转开放手术。平均手术时间164 min（120～240 min）。术后伤口疼痛较轻，且术后第1天平均疼痛视觉模拟评分2.2分（2～3分）。术后平均住院时间2.2 d（2～3 d）。术后1例出现脐部少量血清肿，观察后自愈，未影响手术效果。术后随访时间6～15周，未发现复发患者。 结论头侧入路的TEA术式是安全可行的，可作为治疗中线原发性腹壁疝的一个选择，同时也是对TEA术式的一个补充。此术式扩大了TEA技术的适应证，避免了腹腔内置片修补术的弊端，值得向经验丰富的腔镜疝外科医师有限度推广。

Subxiphoid top-down Endoscopic totally extraperitoneal approach technique for primary ventral hernia repair

ObjectiveInvestigating a novel approach to treat primary midline ventral hernia—Subxiphoid top-down endoscopic totally extraperitoneal approach (TEA). The procedure will be described in details and the safety and efficacy evaluated. MethodsDuring November 2019 and January 2020, six consecutive cases of primary umbilical ventral hernias were repaired using the subxiphoid top-down TEA procedure. A large mesh could be placed in the preperitoneal position using this minimally invasive surgery. ResultsAll operations were successful without open conversion. The mean operation time was 164 minutes (120 to 240 minutes). Postoperative pain was mild and the mean visual analogue pain scale (VAS) was 2.2 on first postoperative day. The average postoperative stay in hospital was 2.2 days (2 to 3 days). One case experienced postoperative mild seroma but without adverse impact on the final outcome and no recurrences during the follow-up period of 6 to 15 weeks. ConclusionSubxiphoid top-down TEA procedure is a safe, feasible and minimally invasive alternative for the surgical treatment of primary ventral hernia. It is an effective supplement of the TEA technique which could expand its indications. This technique is worthy recommended to experienced hernia surgeon.