单切口腹腔镜完全腹膜外与腹腔镜完全腹膜外腹股沟疝修补术的比较：初步经验。
Comparison of single incision laparoscopic totally extraperitoneal and laparoscopic totally extraperitoneal inguinal hernia repair: initial experience.
机构信息
Department of Surgery, University of Zagreb, University Hospital Center Sestre milosrdnice, Zagreb, Croatia.
出版信息
J Endourol. 2012 Jan;26(1):63-6. doi: 10.1089/end.2011.0352. Epub 2011 Oct 14.
BACKGROUND AND PURPOSE
Laparoendoscopic single-site (LESS) surgery has been implemented recently in many laparoscopic (LAP) surgical procedures. We report our initial experience with LESS totally extraperitoneal (LESS-TEP) inguinal hernia repair in relation to conventional LAP-TEP.
PATIENTS AND METHODS
Between November 2008 and May 2009, 25 LESS-TEP repairs of inguinal hernia and 29 LAP-TEP repairs of inguinal hernia were performed in 44 patients. Data regarding patient demographics, type of hernia, operative time, complications, postoperative hospital stay, and recurrence were prospectively collected and analyzed.
RESULTS
All 44 patients were men, aged 17 to 84 years. Of 44 men, 3 had bilateral inguinal hernias in the LESS-TEP group and 7 in the LAP-TEP group. The operative time for bilateral LESS-TEP was 60 ± 15.3 min (range 40-70 min) and 40 ± 21.6 min (range 20-100 min) for unilateral LESS-TEP, while for bilateral hernia LAP-TEP it was 60 ± 24.8 min (range 40-100 min) and for unilateral LAP-TEP it was 50 ± 14.2 min (range 40-80 min). Comparison of operative times in the LESS-TEP and LAP-TEP groups between the first and second half cohort resulted in significant reduction of operative time in the second half of the LESS-TEP group (P<0.001). There were no intraoperative complications. Discharge was within 72 hours for most patients in both groups. There was one early recurrence (mesh displacement) during a median follow-up period of 11.5 ± 2.5 months in the LESS-TEP group and no recurrences during the 11 ± 1.6 months in the LAP-TEP group.
CONCLUSION
In our experience, LESS-TEP is a safe and feasible procedure with a short learning curve. In all analyzed parameters, it is comparable to conventional LAP-TEP. Further studies that compare LESS-TEP and conventional multiport LAP-TEP repairs with long-term follow-up evaluation are needed to confirm the initial experience.
背景与目的
腹腔镜单部位（LESS）手术最近已在许多腹腔镜（LAP）手术中实施。我们报告了与传统 LAP-TEP 相比，我们在完全腹膜外（LESS-TEP）腹股沟疝修补术中的初始 LESS 经验。
患者和方法
在 2008 年 11 月至 2009 年 5 月期间，44 例患者接受了 25 例 LESS-TEP 修补术和 29 例 LAP-TEP 修补术治疗腹股沟疝。前瞻性收集并分析了患者人口统计学数据、疝类型、手术时间、并发症、术后住院时间和复发情况。
结果
所有 44 例患者均为男性，年龄 17 至 84 岁。在 44 名男性中，3 名在 LESS-TEP 组中患有双侧腹股沟疝，7 名在 LAP-TEP 组中患有双侧腹股沟疝。双侧 LESS-TEP 的手术时间为 60 ± 15.3 分钟（范围 40-70 分钟），单侧 LESS-TEP 为 40 ± 21.6 分钟（范围 20-100 分钟），而双侧 LAP-TEP 的手术时间为 60 ± 24.8 分钟（范围 40-100 分钟），单侧 LAP-TEP 的手术时间为 50 ± 14.2 分钟（范围 40-80 分钟）。比较 LESS-TEP 和 LAP-TEP 组在第一和第二半队列中的手术时间，结果显示 LESS-TEP 组的手术时间在第二半队列中显著减少（P<0.001）。两组术中均无并发症。两组大多数患者的出院时间均在 72 小时内。在 LESS-TEP 组的中位随访期 11.5 ± 2.5 个月内，有 1 例早期复发（网片移位），而在 LAP-TEP 组的 11 ± 1.6 个月内，无复发。
结论
根据我们的经验，LESS-TEP 是一种安全可行的手术方法，学习曲线较短。在所有分析的参数中，它与传统的 LAP-TEP 相当。需要进一步的研究比较 LESS-TEP 和传统多端口 LAP-TEP 修复术，并进行长期随访评估，以证实初始经验。
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