标准腹腔镜下单部位手术（LESS）与完全腹膜外（TEP）腹股沟疝修补术的对比研究。
A comparative study of standard versus laparoendoscopic single-site surgery (LESS) totally extraperitoneal (TEP) inguinal hernia repair.
机构信息
Division of Urology, Department of Surgery, Buddhist Tzu Chi General Hospital, Taipei Branch, Taipei, Taiwan.
出版信息
Surg Endosc. 2011 Sep;25(9):2879-83. doi: 10.1007/s00464-011-1636-y. Epub 2011 Jun 11.
BACKGROUND
Laparoscopic inguinal hernia repair has been around since the 1990s. A novel surgical approach known as laparoendoscopic single-site surgery (LESS) has been developed to reduce the port-related morbidities and improve the cosmetic outcomes of laparoscopic surgery, including totally extraperitoneal (TEP) inguinal hernia repair. The aim of the present study was to evaluate the safety and feasibility of the LESS TEP technique for inguinal hernia repair and compare the outcomes with the standard TEP approach.
METHODS
Between January and May 2009, 54 consecutive healthy patients (48 men and 6 women) underwent LESS TEP inguinal hernia repair at our institute. All procedures were performed using our homemade single port for simultaneous passage of the laparoscope and instruments. The perioperative data, including patient age, sex, body mass index (BMI), hernia characteristics, operative time, complications, length of hospital stay, return to normal activity, pain score, and cosmetic result, were prospectively collected.
RESULTS
All LESS TEP procedures were completed successfully without conversion to standard laparoscopic or open surgery. A total of 98 LESS TEP hernia repairs were performed in 54 patients and compared with 152 standard TEP operations. The mean operative time was significantly shorter in the standard TEP series (61.8 ± 26.0 vs. 70.9 ± 23.8 min, p = 0.04). Other perioperative parameters, including the length of hospital stay, time until return to full activity, complication rate, pain score, and cosmetic result, were all comparable between the two techniques.
CONCLUSION
Our short-term experience with LESS TEP inguinal hernia repair has shown that in experienced hands, inguinal hernia repair via the LESS TEP technique is as safe as the standard TEP technique. However, based on our evidence, we currently believe that the LESS TEP technique is not an efficacious surgical alternative to the standard TEP technique for inguinal hernias.
背景
腹腔镜腹股沟疝修补术自 20 世纪 90 年代以来一直存在。一种新的手术方法，称为经腹腔镜单部位手术（LESS），已经被开发出来，以减少与端口相关的发病率，并改善腹腔镜手术的美容效果，包括完全腹膜外（TEP）腹股沟疝修补术。本研究的目的是评估 LESS TEP 技术治疗腹股沟疝的安全性和可行性，并将结果与标准 TEP 方法进行比较。
方法
2009 年 1 月至 5 月，我院连续收治 54 例健康患者（男 48 例，女 6 例）行 LESS TEP 腹股沟疝修补术。所有手术均采用自制单孔同时通过腹腔镜和器械。前瞻性收集围手术期数据，包括患者年龄、性别、体重指数（BMI）、疝特征、手术时间、并发症、住院时间、恢复正常活动时间、疼痛评分和美容效果。
结果
所有 LESS TEP 手术均成功完成，无转换为标准腹腔镜或开放手术。54 例患者共完成 98 例 LESS TEP 疝修补术，并与 152 例标准 TEP 手术进行比较。标准 TEP 组的平均手术时间明显缩短（61.8±26.0 分钟比 70.9±23.8 分钟，p=0.04）。其他围手术期参数，包括住院时间、恢复正常活动时间、并发症发生率、疼痛评分和美容效果，两种技术之间均无差异。
结论
我们在 LESS TEP 腹股沟疝修补术方面的短期经验表明，在有经验的医生手中，LESS TEP 技术治疗腹股沟疝与标准 TEP 技术一样安全。然而，根据我们的证据，我们目前认为 LESS TEP 技术不是治疗腹股沟疝的一种有效的替代标准 TEP 技术。
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