倒刺线缝合假性疝囊预防直疝术后血清肿应用研究

doi:10.3969/j.issn.1009-976X.2022.04.009

摘要/Abstract

摘要： 目的探讨在腹腔镜腹股沟疝修补术中使用倒刺线处理腹股沟直疝假性疝囊预防术后血清肿的效果。方法 2020年1月1日至2021年1月31日期间就收治的54名腹股沟直疝患者,并将其随机分为倒刺线缝合组和对照组（假性疝囊旷置）。主要结果是比较术后7天、1个月、3个月和6个月腹股沟区域的超声血清肿数量和体积。次要结果包括总手术时间、术后急性疼痛、慢性疼痛、住院时间及复发率。结果 54例患者均在腹腔镜下顺利完成腹股沟直疝无张力修补术,两组患者基本资料统计学特征无显著差异,包括年龄、性别、疝类型、疝缺损大小、手术方式和随访时间。倒刺线缝合组手术时间长于对照组（55.13 min vs. 41.15 min;P<0.001）。然而与对照组相比,倒刺线缝合组术后7天、1个月出现血清肿的患者明显减少（分别P<0.001和P=0.05）。两组3个月及6个月血清肿比较无明显差异。术后第7天和1个月,倒刺线缝合组超声血清肿量较对照组明显减少,差异有统计学意义（分别P<0.001和P<0.01）。两组急性疼痛和住院时间无统计学差异,随访期间两组均未观察到慢性疼痛、早期复发或其他术后并发症。结论腹腔镜腹股沟直疝修补术使用倒刺线缝合假性疝囊对于预防术后血清肿是一种安全、有效、可靠的技术,不增加术后疝复发率及慢性疼痛,值得临床进一步研究。

关键词: 疝, 腹股沟, 腹腔镜, 血清肿, 倒刺线

Abstract: Objective To investigate the efficacy of the preventive effect of a simple technique by closing the direct hernia defect with barbed suture in laparoscopic direct inguinal hernia. Methods In total, 54 patients who presented to our hospital between January 1, 2020 and January 31, 2021 with primary direct inguinal hernia were randomized into the defect-closing group （by closing the transversalis） and the control groups. The primary outcomes were to compare the ultrasonic seroma number and volume at the inguinal region at 7 days, 1, 3 and 6 months postoperatively. Secondary outcomes included total operative time, acute pain, chronic pain, hospital stay, recurrence, and any other complications. Results All patients underwent surgery successfully. There were no significant differences in baseline demographic characteristics between the 2 groups including age, sex, hernia type, size of hernia defect, surgical approach, and follow-up time. Compared with control group, there were significantly fewer patients with seroma formation at 7 days, and 1 months after the operations in the defect closing group （P < 0.001, P = 0.05, respectively）. In addition, ultrasonic seroma volume was less in the defect-closing group on postoperative day 7 and 1 months （P < 0.001, P < 0.01, respectively）. The acute pain and hospital stay were comparable, and no chronic pain, early recurrence or other postoperative complications observed in both groups during the follow-up period. Conclusion The closure of pseudohernia sac with barbed suture in laparoscopic direct inguinal hernia repair is a secure and effective technique, which is easy to perform and could significantly reduce both incidence and volume of seroma formation without increasing the risk of recurrence, acute, and chronic pain.

Key words: hernia, inguinal, laparoscopes, seroma, barbed suture

中图分类号:

R656.2

莫宇轩, 汤凌佳. 倒刺线缝合假性疝囊预防直疝术后血清肿应用研究[J]. 岭南现代临床外科, 2022, 22(04): 363-368.

MO Yu-xuan, TANG Ling-jia. Closure of a direct inguinal hernia defect with barbed suture for seroma prevention in laparoscopic direct inguinal hernia repair[J]. Lingnan Modern Clinics In Surgery, 2022, 22(04): 363-368.

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