T型离断与疝囊剥离在腹腔镜经腹膜前斜疝修补手术的临床应用

目的对比分析T型离断与疝囊完全剥离技术两种处理方式在腹腔镜经腹腹膜前疝修补术（TAPP）临床应用中的安全性和有效性。 方法收集解放军联勤保障部队第904医院自2017年1月至2019年12月确诊并收治的单侧腹股沟斜疝的男性127例患者的临床资料，其中行T型离断的患者67例（T型离断组），行疝囊完全剥离的患者60例（完全剥离组）；对2组患者的临床资料进行回顾性分析，比较2组患者的手术时间、疝囊处理时间、术中出血量、精索损伤、术后疼痛评分、术后血清肿和远期复发情况等。 结果T型离断组的手术时间、处理疝囊时间、术中出血量、术中精索血管和输精管损伤控制、术后血清肿的发生率均优于完全剥离组，差异有统计学意义（P<0.05）；2组术中腹壁下血管损伤、术后发生切口感染、尿潴留及阴囊积液比较，差异均无统计学意义（P>0.05）；2组术后早期疼痛评分、远期慢性疼痛发生率及术后复发率比较，差异均无统计学意义（P>0.05）。 结论T型离断技术在TAPP术中能显著缩短手术时间、减少术中出血、降低术中精索意外损伤从而降低手术难度，且在术后早期及远期并发症控制的效果均不劣于完全剥离疝囊组，是一种安全有效的手术方式。

Clinical application of T-shaped incision dissection and hernia sac dissection during transabdominal preperitoneal inguinal hernia repair

ObjectiveTo compare and analyze the safety and effectiveness of T-shaped incision dissection and hernia sac dissection in the clinical application of laparoscopic transabdominal preperitoneal hernia repair (TAPP). MethodsCollected clinical data of 127 male patients with unilateral inguinal hernia diagnosed and admitted to the 904th Hospital of the Joint Logistics Support Unit of the PLA from January 2017 to December 2019, 67 patients with T-shaped incision dissection and 60 patients with hernia sac dissection; a retrospective analysis of the clinical data of the two groups of patients, comparing the operation and hernia sac treatment time, intraoperative blood loss, spermatic cord injury, postoperative pain score, postoperative seroma and long-term recurrence etc. ResultsIn the group of T-shaped incision dissection, operation time, time for hernia sac treatment, intraoperative blood loss, intraoperative spermatic cord blood vessel and vas deferens injury, the incidence of control and postoperative seroma were better than that in the hernia sac dissection group, and the difference was statistically significant (P<0.05). Intraoperative abdominal wall vascular injury, postoperative incision infection, urinary retention and scrotal effusion were no statistically significant difference (P>0.05); there was no significant difference in the early postoperative pain score and long-term chronic pain incidence between the two groups (P>0.05); there was no statistically significant difference in postoperative recurrence (P>0.05). ConclusionThe T-shaped incision dissection technique can significantly shorten the operation time, reduce intraoperative bleeding, and reduce the accidental injury of the spermatic cord during TAPP surgery, thereby reducing the difficulty of surgery, and the early and long-term complications control is not worse than the hernia sac striped group. It was a safe and effective surgical treatment.