完全腹膜外延伸视野入路与腹腔镜腹腔内平铺补片治疗腹壁疝的疗效比较：单中心初步回顾性研究。
Efficacy of extended view totally extra peritoneal approach versus laparoscopic intraperitoneal on lay mesh plus for abdominal wall hernias: a single center preliminary retrospective study.
机构信息
The Second Clinical Medical College, Jinan University, Shenzhen, China.
Department of Hepatobiliary and Pancreatic Surgery, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, Shenzhen, 518020, Guangdong Province, China.
出版信息
BMC Surg. 2023 Jul 13;23(1):200. doi: 10.1186/s12893-023-02098-0.
BACKGROUND
Laparoscopic minimally invasive surgery has become the primary treatment for ventral hernias. The laparoscopic intraperitoneal on lay mesh (IPOM) plus approach for abdominal wall hernias is the most used procedure, while extended view totally extraperitoneal (e‑TEP) repair is a newer option. This study aimed to compare the effectiveness and complications of the 2 procedures for abdominal wall hernias repair.
METHODS
This was a retrospective and comparative single-center study done at The Second Clinical Medical College, Jinan University Hospital (Shenzhen People's Hospital), Shenzhen, China. The study included patients with a 2 to 6 cm abdominal wall defect who underwent hernia repair from January 2022 to December 2022. Patients' baseline characteristics, hernia features, operative time, blood loss, postoperative pain level, and total hospitalization expenses were extracted from the medical records and compared between patients who underwent the IPOM plus and e-TEP repair.
RESULTS
A total of 53 patients were included: 22 in the e-TEP group and 31 in IPOM plus group. Patient demographic characteristics were similar between the 2 groups. The operation time of the e-TEP groups was significantly longer than the IPOM plus (98.5 ± 10.7 min vs. 65.9 ± 7.3 min, P < 0.01). Postoperative pain levels (VAS; visual analog scale) (4.2 ± 0.9 vs. 6.7 ± 0.9, P < 0.01), analgesic requirements (Tramadol) (25.0 ± 37.0 mg vs. 72.6 ± 40.5 mg, P < 0.01), length of hospital stay (1.2 ± 0.5days vs. 2.2 ± 0.6days, P < 0.01), and total hospitalization expenses (19695.9 ± 1221.7CNY vs. 35286.2 ± 1196.6CNY, P < 0.01) were significantly lower in the e-TEP group. The mean intraoperative blood loss was similar between the 2 groups. No postoperative complications were observed in either group.
CONCLUSION
The e-TEP approach for abdominal wall hernias appears to be better than IPOM plus with respect to postoperative pain levels(VAS: 4.2 ± 0.9 vs. 6.7 ± 0.9, P < 0.01), analgesic requirements(25.0 ± 37.0 mg vs. 72.6 ± 40.5 mg, P < 0.01), length of hospital stay(1.2 ± 0.5days vs. 2.2 ± 0.6days, P < 0.01), and hospitalization costs (19695.9 ± 1221.7CNY vs. 35286.2 ± 1196.6CNY, P < 0.01).
背景
腹腔镜微创手术已成为治疗腹疝的主要方法。腹腔镜腹腔内补片置入术（IPOM）加方法是最常用的治疗腹壁疝的方法，而扩展视野完全腹膜外（e-TEP）修复是一种较新的选择。本研究旨在比较两种手术方法治疗腹壁疝的效果和并发症。
方法
这是一项在中国深圳大学附属医院（深圳市人民医院）第二临床医学院进行的回顾性、对照性单中心研究。研究纳入了 2022 年 1 月至 12 月期间接受疝修补术的 2 至 6cm 腹壁缺损患者。从病历中提取患者的基线特征、疝特征、手术时间、失血量、术后疼痛程度和总住院费用，并比较 IPOM 加组和 e-TEP 修复组患者的这些数据。
结果
共纳入 53 例患者：e-TEP 组 22 例，IPOM 加组 31 例。两组患者的人口统计学特征相似。e-TEP 组的手术时间明显长于 IPOM 加组（98.5±10.7min 比 65.9±7.3min，P<0.01）。术后疼痛水平（VAS；视觉模拟评分）（4.2±0.9 比 6.7±0.9，P<0.01）、镇痛需求（曲马多）（25.0±37.0mg 比 72.6±40.5mg，P<0.01）、住院时间（1.2±0.5 天比 2.2±0.6 天，P<0.01）和总住院费用（19695.9±1221.7 人民币比 35286.2±1196.6 人民币，P<0.01）在 e-TEP 组明显更低。两组术中平均失血量相似。两组均未观察到术后并发症。
结论
与 IPOM 加组相比，e-TEP 治疗腹壁疝在术后疼痛水平（VAS：4.2±0.9 比 6.7±0.9，P<0.01）、镇痛需求（25.0±37.0mg 比 72.6±40.5mg，P<0.01）、住院时间（1.2±0.5 天比 2.2±0.6 天，P<0.01）和住院费用（19695.9±1221.7 人民币比 35286.2±1196.6 人民币，P<0.01）方面均具有优势。
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