Application and clinical significance of membrane as anatomic marker in laparoscopic totally extraperitoneal inguinal hernioplasty
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摘要:目的
探讨以膜为解剖标志在腹腔镜完全腹膜外腹股沟疝修补术（TEP）中的应用及临床意义。
方法选择确诊的100例腹股沟疝患者，将其分为观察组（n=50）和对照组（n=50）。对照组采用TEP，观察组采用以膜为解剖标志的TEP。比较2组手术时间、引流管放置时间、住院时间、操作空间建立时间、应激激素等指标。
结果2组术中出血量、操作空间建立时间、引流管放置时间、引流液总量、术后疼痛评分、住院时间比较，差异均有统计学意义（P < 0.05）；手术前，2组皮质醇（Cor）、去甲肾上腺素（NE）、醛固酮（ALD）水平比较，差异均无统计学意义（P>0.05）；术后，观察组Cor、NE和ALD水平分别为（261.23±12.35）nmol/L、（96.56±13.32）μg/L和（13.26±2.84）ng/dL，低于对照组的（415.12±14.41）nmol/L、（108.36±15.63）μg/L和（20.26±3.10）ng/dL，差异均有统计学意义（P < 0.05）。
结论以膜为解剖标志的腹腔镜TEP能够安全、快捷、有效地建立手术操作空间，加快患者康复，减轻患者创伤应激反应。因此，精准理念指导下的腹腔镜TEP是安全可靠的，值得临床推广。
Abstract:ObjectiveTo investigate the application and clinical significance of using membrane as anatomical marker in laparoscopic totally extraperitoneal inguinal hernioplasty (TEP).
MethodsA total of 100 patients with inguinal hernia were selected and divided into observation group (n=50) and control group(n=50). The control group performed TEP, while the observation group performed TEP taking membrane as anatomic mark. Operation time, drainage tube placement time, hospital stay, establishment time of operation space and stress hormone were compared between the two groups.
ResultsThere were significant differences in intraoperative blood loss, operation space establishment time, drainage tube placement time, total volume of drainage fluid, postoperative pain score and hospital stay between the two groups (P < 0.05). Before operation, there were no significant differences in levels of cortisol (Cor), norepinephrine (NE) and aldosterone (ALD) in two groups (P>0.05). After operation, the levels of Cor, NE and ALD in the observation group were (261.23±12.35) nmol/L, (96.56±13.32) μg/L and (13.26±2.84) ng/dL, respectively, which were lower than (415.12±14.41) nmol/L, (108.36±15.63) μg/L and (20.26±3.10) ng/dL in the control group, and the differences were statistically significant (P < 0.05).
ConclusionLaparoscopic TEP using membrane as anatomic landmark can safely, quickly and effectively establish the surgical operation space, accelerate the recovery, and relieve the traumatic stress response of patients. Laparoscopic TEP under the guidance of precision concept is safe and reliable, and is worthy of clinical promotion.
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Keywords:
- peritoneum /
- inguinal hernia /
- laparoscope /
- tension-free repair /
- operating space /
- anatomic landmark
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表 1 2组围术期手术主要相关指标比较(x±s)
组别 n 术中出血量/mL 操作空间建立时间/min 引流管放置时间/d 引流液量/mL 术后疼痛评分/分 住院时间/h 观察组 50 6.93±2.31* 45.00±6.12* 1.32±0.71* 56.00±7.13* 2.10±0.6* 71.00±4.23* 对照组 50 9.56±3.12 56.00±4.60 2.61±1.00 122.00±5.72 4.23±0.6 98.00±3.53 与对照组比较, *P < 0.05。 
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表 2 围术期应激激素水平比较(x±s)
组别 Cor/(nmol/L) NE/(μg/L) ALD/(ng/dL) 术前 术后 术前 术后 术前 术后 对照组 200.12±11.55 415.12±14.41 67.54±11.56 108.36±15.63 8.13±1.36 20.26±3.10 观察组 203.16±11.36 261.23±12.35* 67.06±11.01 96.56±13.32* 8.12±1.32 13.26±2.84* Cor: 皮质醇; ALD: 醛固酮; NE: 去甲肾上腺素。与对照组比较, *P < 0.05。
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