经腹探查全腹膜外腹腔镜腹股沟疝修补术的临床研究

目的 探讨经腹探查的腹腔镜全腹膜外腹股沟疝修补术（le-TEP）临床可行性及优越性。方法 回顾性分析北京大学深圳医院肝胆外科2015年01月到2018年12月期间施行的434例成人腹股沟疝手术,其中226例行预先经腹探查的TEP（le-TEP组）,208例行传统TEP（TEP组）。记录患者一般资料、术中和术后相关指标、并发症和复发率。结果 两组患者的一般资料、漏气入腹率、中转手术率、出血量、手术时间、精索腹壁化时间、NRS疼痛评分、下床时间、术后住院时间、近期并发症、远期并发症、真性复发率差异无统计学意义。Le-TEP组的OCH发现率（19.0%）大于TEP组（2.4%）（P<0.001）。Le-TEP组的联合手术率（6.6%）大于TEP组的联合手术率（1.4%）（P<0.05）。Le-TEP组的假性复发疝发生率（1.0%）低于TEP组的假性复发疝复发率（6.1%）（P<0.05）。结论 Le-TEP术式安全,具有可行性,可以提高OCH的检出率,使联合腹腔镜手术同期进行成为可能,减少成人腹股沟疝假性复发疝发生率。

A clinical study of initial laparoscopic exploration in totally extraperitoneal herniorrhaphy for inguinal hernia

Objective To investigate the clinical feasibility and superiority of initial laparoscopic exploration in totally extraperitoneal inguinal herniorrhaphy（le-TEP）. Methods From Jan. 2015 to Dec. 2018,consecutive 434 patients in Peking University Shenzhen Hospital were divided into conventional and modified TEP groups. Modified TEP（an initial laparoscopic exploration performed before TEP, le-TEP group） had been introduced in 226 patients and conventional TEP（TEP group）have been introduced in 208 patients. Information about registered patients includes general data,intraoperative and postoperative indicators, complications and recurrence rate were recorded. Results There was no statistically significant difference between two groups in terms of the general date,gas leakage rate,the operative transshipment rate,blood transfusion,the surgical time,the time of peritonealization of spermatic cord, the postoperative NRS pain score,the mean recovery time for general physical activities,postoperative mean hospital stay,short-term and long-term complications, the ture recurrent rate after operation. The detection rate of OCH （occult contralateral hernia） in le-TEP group（19.0%） was significantly higher than that in TEP group（2.4%）（P<0.001）. The combined laparoscopic procedures rate in le-TEP group（6.6%） was higher than that in TEP group（1.4%）（P<0.05）. The pseudo-recurrent rate after operation in le-TEP group（1.0%） was lower than that in TEP group（6.1%）（P<0.05）. Conclusion Le-TEP is safe and feasible, and is superior for increasing the detection rate of contralateral occult hernia,accomplishing the combination of other laparoscopic procedure easily and reducing the pseudo-recurrent rate of adult inguinal hernia.