弓状线变异在腹腔镜完全腹膜外疝修补术中的临床意义

摘要

目的 探讨弓状线变异在腹腔镜全腹膜外疝修补术中的临床意义.方法 分析2015年1月至2018年1月,广东医科大学茶山医院120例腹股沟疝患者弓状线的位置和形态,根据脐至弓状线的长度分为5组病例:经典弓状线组(3～5 cm)、高位弓状线组(2 cm内)、低位弓状线组(6～10 cm)、多条弓状线组和无弓状线组.采用视觉模拟评分法评定各组手术视野清晰度和手术难易度,同时记录各组手术时间,分析术中、术后并发症和复发率与弓状线变异的关系.结果 120例患者脐至耻骨联合上缘的平均距离为13 cm.弓形线位于脐下2～10 cm处,5组病例中经典组69例(57.5％),高位组8例(6.7％),低位组18例(15.0％),多条弓状线组23例(19.2％),无弓状线组2例(1.7％).与经典组相比,高位组在手术视野清晰度和手术难易度比较,差异无统计学意义(P＞0.05),然而另外3组异常弓状线病例(即低位组、多条弓状线组和无弓状线组),无论在手术视野清晰度还是手术难易度方面评分均有明显的下降,而且手术时间明显延长,差异有统计学意义(P＜0.05).此外,这3组病例的腹膜损伤率、血肿发生率和中转手术发生率明显高于经典组,差异均有统计学意义(P＜0.05),但在血清肿、切口感染、疼痛和复发率方面比较,差异无统计学意义(P＞0.05).结论 本组经典弓状线病例仅占总数的57.7％,而变异弓状线发生率为42.5％,其中低位组、多条弓状线组和无弓状线组的变异不仅加大了腹腔镜全腹膜外疝修补术手术难度,而且增加了手术并发症.疝外科医师应当熟知弓状线的变异,提高手术安全性和降低手术并发症.%Objective The aim of this study is to explore the clinical significance ofarcuate line variations in totally extraperitoneal preperitoneal hemiorrhaphy (TEP).Methods 120 cases of TEP were performed in patients with inguinal hernia in Chashan Hospital Affiliated to Guangdong Medical University between January 2015 and January 2018.The arcuate line was recorded and divided into five groups:traditional group (3 to 5 cm),high level group (less than 2 cm),low level group (6 to 10 cm),and multiple arcuate lines group and absent arcuate line group.Endoscopic vision and ease of procedure were measured by means of visual analogue scale (VAS).Operation time,peritoneal injury,emphysema,hematoma,seroma,infection,chronic pain and recurrence were analyzed.Results The average distance between the umbilicus and the symphysis pubis was 13 cm.The arcuate line was located between 2 to 10 cm below the umbilicus,with 69 cases (57.5％) in the traditional group,8 cases (6.7％) in high group,18 cases (15.0％) in low group,and 23 cases (19.2％) in multiple group,and 2 cases (1.7％) in absent group.There was no significant difference in VAS of endo-vision and ease of procedure between the traditional group and the high group (P＞0.05).However,there was a significant difference in VAS of endo-vision and ease of procedure between the traditional group and the remaining three groups (low group,multiple group and absent group) (P＜0.05).The incidence of peritoneal injury,hematoma and conversion in the three variation groups was higher than that in traditional group (P＜0.05),while there was no significant difference in seroma,infection,chronic pain and recurrence between traditional group and these variation groups (P＞0.05).Conclusions The arcuate line in the traditional group accounted for 57.7％,while the arcuate line variations were found in 42.5％ of all cases.They not only increased the level of surgical difficulty,but also were associated with higher complications.The hernia surgeon should keenly realize the variations ofarcuate line for a successful and safe TEP.