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| 疝囊主动横断联合远端关闭治疗腹股沟斜疝的效果分析 |
| Effect of active transection of hernia sac combined with distal closure in the treatment of indirect inguinal hernia |
| 投稿时间：2025-11-17 |
| DOI：10.3969/j.issn.1000-0399.2026.08.009 |
| 中文关键词: 疝囊横断 疝囊关闭 腹腔镜下经腹腹膜前疝修补术 血清肿 |
| 英文关键词: Hernia sac transection Hernia sac closure Transabdominal preperitoneal hernia repair Seroma |
| 基金项目:宝鸡市卫生健康委员会2023年度科研计划(编号:2023-094) |
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| 中文摘要: |
| 目的 明确疝囊主动横断联合远端关闭在腹股沟斜疝治疗中的临床疗效，重点评估其减少血清肿的作用，为优化疝囊处理策略提供依据。方法 回顾性分析宝鸡市人民医院普外科2021年1月至2023年12月行腹腔镜经腹腹膜前疝修补术治疗的单侧腹股沟斜疝147例患者资料；按疝囊处理方式分为观察组（73例，疝囊主动横断联合远端关闭）与对照组（74例，传统的疝囊横断加远端旷置）。比较两组患者的一般资料、围手术期指标、术后并发症及复发情况，采用单因素及多因素logistic回归方法分析血清肿的危险因素。结果 与对照组比较，观察组血清肿发生率（38.4%比64.9%，χ2=10.341,P=0.001）、阴囊积液发生率（1.4%比9.5%,Fisher精确检验，P=0.046）降低；随访≥6个月两组均无复发。单因素分析显示手术方式、疝囊长度、身体质量指数、病史与血清肿相关（P<0.1），多因素logistic回归分析显示，手术方式（OR=0.262,95%CI:0.121～0.566,P=0.001）及疝囊长度（OR=1.793,95%CI:1.196～2.689,P=0.005）是影响血清肿发生的危险因素。结论 疝囊主动横断联合远端关闭在腹股沟斜疝治疗中安全有效，可明显降低血清肿、阴囊积液发生率，具备临床推广价值。 |
| 英文摘要: |
| Objective To clarify the clinical efficacy of intentional hernial sac transection combined with distal closure in the treatment of indirect inguinal hernia, with a focus on evaluating its effect on reducing seroma formation, so as to provide evidence for optimizing the surgical strategy of hernial sac management. Methods A retrospective analysis was conducted on 147 patients with unilateral indirect inguinal hernia who underwent laparoscopic transabdominal preperitoneal(TAPP) hernia repair in the Department of General Surgery of Baoji People's Hospital between January 2021 and December 2023. According to different hernial sac management methods, the patients were divided into the observation group(73 cases, receiving intentional hernial sac transection combined with distal closure) and the control group(74 cases, receiving conventional hernial sac transection with distal sac abandonment). General baseline data, perioperative indicators, postoperative complications and recurrence rate were compared between the two groups. Univariate and multivariate Logistic regression analyses were performed to identify the risk factors for postoperative seroma. Results There were no significant differences between the two groups in baseline characteristics including age, body mass index(BMI), disease course, scrotal hernia, hernia location, hernia classification, comorbidities and ASA physical status classification(all P>0.05). No statistically significant differences were observed in operative time, intraoperative blood loss, hernial sac length, time to first postoperative flatus, 24-hour postoperative Visual Analogue Scale(VAS) score and postoperative hospital stay(all P>0.05). Compared with the control group, the observation group presented significantly lower incidence rates of seroma(38.4% vs. 64.9%, χ2=10.341, P=0.001) and scrotal hydrocele(1.4% vs. 9.5%, Fisher's exact test, P=0.046), while no significant differences were found in the incidence of other complications(all P>0.05). No hernia recurrence was observed in either group during a follow-up period of no less than 6 months. Univariate analysis indicated that surgical method, hernial sac length, BMI and disease history were correlated with seroma formation(P<0.1). Multivariate logistic regression analysis revealed that surgical method(OR=0.262, 95%CI:0.121～0.566, P=0.001) and hernial sac length(OR=1.793, 95%CI:1.196～2.689, P=0.005) were independent risk factors for postoperative seroma. Conclusion Intentional hernial sac transection combined with distal closure is safe and effective for the treatment of indirect inguinal hernia. It can significantly reduce the incidence of seroma and scrotal hydrocele, and is worthy of clinical popularization and application. |
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