程序化耻骨肌孔区域空间解剖在全腹膜外疝修补术中的应用分析

Application analysis of programmed spatial anatomy of the pubic symphysis hernia ring in abdominal wall hernia repair

摘要:

目的 探讨程序化耻骨肌孔区域空间解剖手术技术在腹腔镜下全腹膜外疝修补术（TEP）中的应用效果。方法 选取2019年5月—2021年5月在江苏大学附属武进医院行TEP的121例单侧腹股沟疝患者进行回顾性队列研究。按照不同的手术方式分为程序化组（63例）和传统组（58例）。程序化组行程序化耻骨肌孔空间解剖联合TEP；传统组行TEP。观察并比较两组围手术期相关评估指标及术后并发症的情况。结果 程序化组术中手术时间、术后下床活动时间、术后住院时间、术中处理疝囊时间，以及VAS-24、VAS-48时间较传统组缩短（P <0.05），术中出血量较传统组减少（P <0.05）。程序化组在腹膜破损、腹壁下动脉损伤、感觉神经异常及慢性疼痛占比较传统组下降（P <0.05），而术后血清肿比较，差异均无统计学意义（P >0.05）。结论 程序化耻骨肌孔区域空间解剖手术技术的应用可显著提高TEP的临床效果，可明显改善患者术中及术后相关临床指标，降低术后并发症的发生率，适用于在年轻医师和基础医院中推广。

Abstract:

Objective To investigate the application effect of programmed spatial anatomy of the pubic symphysis hernia (PSH) region in laparoscopic totally extraperitoneal hernia repair (TEP).Methods A retrospective cohort study was conducted on 121 patients with unilateral inguinal hernia who underwent TEP at Wujin Hospital Affiliated to Jiangsu University from May 2019 to May 2021. Patients were divided into the programmed group (63 cases) and the traditional group (58 cases) according to different surgical techniques. The programmed group underwent programmed spatial anatomy of the PSH region combined with TEP, while the traditional group underwent TEP alone. Perioperative evaluation indicators and postoperative complications were observed and compared between the two groups.Results In the programmed group, the operative time, postoperative ambulation time, length of hospital stay, time to handle the hernia sac during surgery, as well as VAS-24 and VAS-48 scores were significantly shorter compared to the traditional group (P < 0.05). Intraoperative blood loss was significantly reduced in the programmed group compared to the traditional group (P < 0.05). The incidence of peritoneal damage, inferior epigastric artery injury, sensory nerve abnormalities, and chronic pain was lower in the programmed group compared to the traditional group (P < 0.05), while there was no statistically significant difference in postoperative serum swelling between the two groups (P > 0.05).Conclusion The application of programmed spatial anatomy of the PSH region significantly improves the clinical outcomes of TEP, improves relevant intraoperative and postoperative clinical indicators, reduces the incidence of postoperative complications, and is suitable for promotion among young physicians and basic hospitals.