疝囊主动切开技术在腹股沟斜疝腹腔镜完全腹膜外疝修补术中的应用

目的探讨疝囊主动切开技术在成人腹股沟斜疝腹腔镜完全腹膜外疝修补术（TEP）中的应用价值及临床效果。 方法回顾性分析2018年3月至2020年7月在洪湖市人民医院行腹股沟斜疝TEP手术的225例患者的临床资料，按照疝囊分离方式不同分为2组。观察组患者103例，采取疝囊主动切开分离技术；对照组患者122例，采取疝囊剥离技术。对比分析2组患者手术时间、术后住院时间、术后12 h疼痛评分、手术室费用、术中副损伤（输精管、精索血管、肠管）、并发症发生率（血清肿、切口感染、慢性疼痛）等临床指标。 结果2组患者手术均顺利完成，无中转开放。观察组手术时间（50.2±12.6）min]较对照组（65.6±18.1）min]显著缩短，差异有统计学意义（P<0.05)；2组患者术后住院时间、术后12 h疼痛评分、手术室费用比较，差异均无统计学意义（P>0.05）；观察组较对照组术中副损伤明显减少，但是血清肿发生率明显增加，差异有统计学意义（P<0.05）。术后均随访6个月，2组患者均无肠梗阻、复发、慢性疼痛及补片感染等严重并发症发生。 结论TEP术中主动切开疝囊缩短了手术时间，其操作简单、安全可行，不会影响手术空间，尤其适用于病程较长或粘连严重的疝囊分离困难患者。

Study on the application of active hernia sac incision in TEP surgery for indirect hernia

ObjectiveTo investigate the application value and clinical effect of active hernia sac incision in TEP surgery for adult inguinal hernia. MethodsA retrospective analysis was performed on 225 patients who underwent TEP surgery for inguinal hernia in our hospital from March 2018 to July 2020. There were 103 patients in the active hernia sac incision group (observation group) and 122 patients in the hernia sac stripping group (control group).?Clinical indicators such as operation time, postoperative hospital stay, postoperative 12 h pain score, operating room cost, intraoperative collateral injury (vas deferens, spermatic vessels, intestine), and complication rate (seroma, incision infection, chronic pain) were compared and analyzed in the two groups. ResultsThe operation was completed successfully in the two groups, and no transit was open.?The operation time of the observation group (50.2±12.6) minutes was significantly shorter than that of the control group (65.6±18.1) minutes, the difference was statistically significant (P<0.05);?There were no statistically significant differences in postoperative hospital stay, postoperative 12 hours pain score, or operating room cost between the 2 groups (P>0.05). The intraoperative collateral injuries in the observation group were significantly reduced compared with the control group, but the incidence of seroma was significantly increased, and the difference was statistically significant (P<0.05).?All patients were followed up for 6 months after surgery, and no recurrence, chronic pain, mesh infection or other serious complications occurred in the two groups. ConclusionTEP's active incision of the hernia sac can shorten the operation time. The operation is simple, safe, and feasible, and will not affect the operation space. It is especially suitable for patients with a long course of disease or severe adhesion who have difficulty separating the hernia sac.