后鞘后单孔腹腔镜腹股沟疝修补术中完全可视化建腔技术的应用

doi:10.3877/cma.j.issn.1674-6899.2023.04.004

中华腔镜外科杂志(电子版) ›› 2023, Vol. 16 ›› Issue (04): 216 -219. doi: 10.3877/cma.j.issn.1674-6899.2023.04.004

论著

后鞘后单孔腹腔镜腹股沟疝修补术中完全可视化建腔技术的应用

黄亮亮, 吴卫东, 王廷峰^†(

)

201399　上海，上海市浦东医院，复旦大学附属浦东医院
200080　上海，上海交通大学医学院附属第一人民医院

收稿日期:2023-07-04 出版日期:2023-08-30
通信作者: 王廷峰
基金资助:
上海市卫生健康委(No.202040116); 浦东新区卫生系统学科带头人培养计划(No.PWRd2020-19); 浦东新区临床特色学科项目(No.PWYts2021-01); 复旦大学附属浦东医院特色专病-疝病(No.Tszb2020-01)

The application of completely visualized cavity construction technique in posterior sheath single incision inguinal hernia repair

Liangliang Huang, Weidong Wu, Tingfeng Wang^†()

Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai 201399, China
Shanghai General Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China

Received:2023-07-04 Published:2023-08-30
Corresponding author: Tingfeng Wang

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目的

总结完全可视化建腔技术应用于后鞘后入路单孔腹腔镜腹股沟疝完全腹膜外修补术(single incision laparoscopic totally extraperitoneal hernia repair，SIL-TEP)的初步经验和操作要点。

方法

回顾性分析2023年1月至2023年4月施行的30例经脐后鞘后入路SIL-TEP患者的临床资料。

结果

术中建腔时发生腹膜破损1例(3.3%)，术中出血量(9.50±2.40) ml。手术时间单侧平均(61.04±15.11) min，双侧平均(80.83±16.25) min。切皮到装置置入时间平均(120.77±17.16)s，进入鞘后空间时间平均(249.67±66.71)s。术后24 h疼痛视觉模拟评分平均(2.57±0.73)分，48 h平均(1.97±0.56)分。术后脐部切口感染1例(3.3%)，尿潴留1例(3.3%)，血清肿3例(10%)，皮下瘀血1例(3.3%)，术后随访均未发现慢性疼痛、补片感染及疝复发。

结论

完全可视化建腔技术视野清晰，解剖层次明确，腹膜破损率低，有效降低手术难度，可常规应用于后鞘后SIL-TEP。

关键词: 单孔, 后鞘后入路, 完全腹膜外, 腹膜破损

Objective

To summarize the preliminary experience and key points of the application of completely visualized cavity construction technique in the posterior sheath approach single incision laparoscopic totally extraperitoneal hernia repair (SIL-TEP).

Methods

Retrospective analysis of the clinical data of 30 cases of posterior sheath approach SIL-TEP from Jan. 2023 to Apr. 2023.

Results

The peritoneum injury occurred in 1 patient (3.3%) when establishing the cavity. The bleeding volume was (9.50±2.40) ml. The operation time was (61.04±15.11) min on one side and (80.83±16.25) min on two sides. The time from skin cutting to device insertion was (120.77 ± 17.16) sec. The time to enter the space behind the posterior sheath was (249.67 ± 66.71) sec. The postoperative pain visual analogue score was (2.57 ± 0.73) at 24 hours and (1.97 ± 0.56) at 48 hours. Postoperative umbilical incision infection occurred in 1 patient (3.3%), Urinary retention in 1 patient (3.3%), seroma in 3 patients (10%), and ecchymosis in 1 patient (3.3%). No Chronic pain, patch infection, or recurrence was found in the follow-up.

Conclusions

The completely visualized cavity construction technology has a clear field of vision, clear anatomical hierarchy, low peritoneum injury rate, and effectively reduces surgical difficulty. It can be routinely applied to the posterior sheath SIL-TEP.

Key words: Single incision, Posterior sheath approach, Totally extraperitonea, Peritoneum injury

图1 基底保护圈

图2 手术过程注：A.脐檐正中切口切开暴露皮下脂肪；B.皮下置入基底保护圈；C.基底保护圈放置完毕；D.切开腹直肌前鞘；E.切开腹直肌后鞘；F.切开中线下脂肪向足侧分离；G.沿腹横筋膜分离Retzius间隙；H.建腔完毕后镜下图像。

表1 不同操作步骤腹膜破损发生情况

操作步骤	例数(%)
切开后鞘	1(3.3)
建立通道	0(0)
分离疝囊	8(26.7)
推平腹膜反折线	1(3.3)

表1 不同操作步骤腹膜破损发生情况

操作步骤	例数(%)
切开后鞘	1(3.3)
建立通道	0(0)
分离疝囊	8(26.7)
推平腹膜反折线	1(3.3)

1	Filipovic-Cugura J, Kirac I, Kulis T, et al. Single-incision laparoscopic surgery (SILS) for totally extraperitoneal (TEP) inguinal hernia repair: first case[J]. Surg Endosc, 2009, 23(4)：920-921.
2	Perivoliotis K, Tzovaras G, Sarakatsianou C, et al. Current status of single-port versus multi-port approach in laparoscopic inguinal hernia mesh repair: an up-to-date systematic review and meta-analysis[J]. Hernia, 2019, 23(2)：217-233.
3	Sajid MS, Khawaja AH, Sayegh M, et al. A systematic review comparing single-incision versus multi-incision laparoscopic surgery for inguinal hernia repair with mesh[J]. Int J Surg, 2016, 29：25-35.
4	Lee YJ, Kim JH, Kim CH, et al. Single incision laparoscopic totally extraperitoneal hernioplasty: lessons learned from 1，231 procedures[J]. Ann Surg Treat Res, 2021, 100(1)：47-53.
5	张一忠，陈军杰，唐健松，等. 经脐单孔腹腔镜完全腹膜外腹股沟疝修补术95例[J/CD]. 中华疝和腹壁外科杂志(电子版), 2020, 14(4)：350-354.
6	王廷峰，吴卫东，陈军杰，等. 后鞘后经脐缘单孔腹腔镜完全腹膜外腹股沟疝修补术：500例回顾性分析[J]. 复旦学报(医学版), 2022, 49(5)：697-703.
7	张一忠，齐长磊，帅勇锋，等. 后鞘后入路在单孔腹腔镜全腹膜外腹股沟疝修补术中的应用体会[J]. 腹腔镜外科杂志，2020, 25(7)：497-500.
8	吴卫东，张一忠，王廷峰，等. 单孔腹腔镜腹股沟疝手术规范化操作中国专家共识(2023版)[J]. 中国实用外科杂志，2023, 43(01): 34-47.
9	Białecki JT, Wieloch MM, Kołomecki K. Single incision approach to totally extraperitoneal inguinal hernia repair[J]. Wideochir Inne Tech Maloinwazyjne, 2014, 9(2)：201-206.
10	Kim JH, An CH, Lee YS, et al. Single incision laparoscopic totally extraperitoneal hernioplasty (SIL-TEP): experience of 512 procedures[J]. Hernia, 2015, 19(3)：417-422.
11	吴卫东. 单孔技术在腹外疝治疗中的应用[J/CD]. 中华腔镜外科杂志(电子版), 2020, 13(4)：198-200.
12	Tang R, Jiang H, Wu W, et al. A preliminary multicenter evaluation of endoscopic sublay repair for ventral hernia from China[J]. BMC Surg, 2020, 20(1)：233.
13	Jung S, Lee JH, Chong JU, et al. Prevention and management of intraoperative complication during single incision laparoscopic totally extraperitoneal repair[J]. J Minim Invasive Surg, 2022, 25(1)：36-39.
14	司仙科，王廷峰，李英儒，等．单孔腹腔镜完全腹膜外腹股沟疝修补术学习曲线的影响因素分析[J]. 腹腔镜外科杂志，2023, 28(05)：359-364.
15	Nitta T, Kataoka J, Ohta M, et al. Usefulness of repair using Hem-o-lok? for peritoneal tear as a complication of totally extraperitoneal repair: case series[J]. Ann Med Surg (Lond), 2019, 49：5-8.
16	Zhou E, Qi C, Wang X, et al. Single incision laparoscopic totally preperitoneal hernioplasty (SIL-TPP): Lessons learned from 102 procedures and initial experience[J]. Medicine (Baltimore), 2022, 101(39)：e30882.
17	Tran H, Turingan I, Tran K, et al. Potential benefits of single-port compared to multiport laparoscopic inguinal herniorraphy: a prospective randomized controlled study[J]. Hernia, 2014, 18(5)：731-744.
18	Wijerathne S, Agarwal N, Ramzy A, et al. A prospective randomized controlled trial to compare single-port endo-laparoscopic surgery versus conventional TEP inguinal hernia repair[J]. Surg Endosc, 2014, 28(11)：3053-3058.

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