单点固定法完全腹膜外腹腔镜腹股沟疝修补术的临床研究

目的:探讨单点固定法完全腹膜外腹腔镜腹股沟疝修补术(totally extraperitoneal,TEP)治疗腹股沟疝的可行性及适用性。方法:回顾分析2013年1月至2014年8月确诊并行TEP的50例双侧腹股沟疝男性患者,其中33例行免气囊、免固定的TEP(免固定组),17例行免气囊、单点固定法TEP(单点固定组),分析两组术后使用镇痛药例数、胃肠功能恢复时间、术后下床活动时间、住院时间、术后并发症发生率。结果:与免固定组相比,单点固定组手术时间较短70(55,80)min vs.90(65,105)min,P=0.024],差异有统计学意义;术后应用镇痛药(41.2%vs.39.4%,P=0.903)、术后排气时间(15.2±4.3)h vs.(14.1±4.0)h,P=0.396]、下床活动时间(20.0±2.8)h vs.(20.8±4.1)h,P=0.436]、住院时间3(2,5)d vs.4(3,5)d,P=0.199]、术后血清肿发生率(11.8%vs.21.2%,P=0.341)差异均无统计学意义,两组术后均无复发。结论:与免固定TEP相比,单点固定TEP治疗双侧腹股沟疝可显著缩短手术时间,降低手术难度,是安全、可行的,适合临床应用。

Clinical application research of laparoscopic totally extraperitoneal inguinal hernia repair by using one-point-suturing fixed method

Objective:To investigate the feasibility and applicability of laparoscopic totally extraperitoneal ( TEP ) inguinal her-nia repair by using one-point-suturing method. Methods:Fifty male patients were retrospectively analyzed from Jan. 2013 to Aug. 2014, all of them were diagnosed with bilateral inguinal hernia and treated with TEP surgery. Among them,there were 33 patients with free of air bag and free of fixed TEP ( free fixed group) and 17 patients with free of air bag and fixed by one-point-suturing TEP ( one-point-su-turing fixed group) . They were analyzed about their differences of postoperative pain,gastrointestinal function recovery time,the bedside movement time,the hospitalization time,and the incidence of postoperative complications. Results:Compared with the free fixed group, the operation time of the one-point-suturing fixed group was significantly shorter 70 (55,80) min vs. 90 (65,105) min,P=0. 024], but the differences were not statistically significant in postoperative pain (41. 2% vs. 39. 4%,P=0. 903),gastrointestinal function re-covery time (15. 2±4. 3) h vs. (14. 1±4. 0) h,P=0. 396],the bedside movement time (20. 0±2. 8) h vs. (20. 8±4. 1) h,P=0. 436],the hospitalization time 3 (2,5) d vs. 4 (3,5) d,P=0. 199],the incidence of postoperative seroma (11. 8% vs. 21. 2%,P=0. 341),and there were no recurrences in both groups. Conclusions:Compared with the free fixed TEP,the one-point-suturing fixed TEP has significantly shorter operation time,and can reduce the operation difficulty in repairing bilateral inguinal hernia,so it is safe, feasible and appropriate to application.