摘要
目的探讨使用自制雪橇针三尾固定缝线的单手四针缝合法关闭腹股沟直疝假疝囊的效率和效果。方法采用随机对照试验方法，前瞻性纳入2014年1月至2018年1月中山大学附属第六医院行腹腔镜下经腹腔腹膜前疝修补术（TAPP）的成年、单侧腹股沟直疝患者，排除复发疝、双侧疝、复合疝者，共156例患者纳入研究。根据随机数字表法将患者分为单手四针缝合组（76例）和传统钉合组（80例）。单手四针缝合组采用雪橇针三尾固定缝线，进行连续四针法缝合固定。雪橇针三尾线制作方法为用普通持针器将3-0、1/2圈弯针的薇乔线的针尾部掰直，成为雪橇状；将线重叠摆好，双线做1个单结，将此单结收紧，将针端线尾绕过该单结结环中，两端线尾倚靠第1个结再打第2个结，收紧线结，将带针一端线尾留下（长约12 cm），剪去线环端（留长约0.6 cm）及另一端线尾（留长约1.5 cm）。传统钉合组采用疝修补钉枪，将假疝类钉合于耻骨梳韧带上。本研究经医院伦理审批通过（审批号：L2014ZSLYEC-016）。比较两组手术时间、假疝囊关闭时间、住院费用、术后并发症发生率、视觉模拟评分及复发率。结果单手四针缝合组和传统钉合组患者年龄分别为（60.2±0.4）岁和（61.1±0.7）岁，男性比例分别为93.4%（71/76）和92.5%（74/80），体质指数分别为（25.1±0.2）kg/m2和（24.9±0.2）kg/m2，假疝囊缺憾损大小分别为（16.1±0.4）cm2和（15.7±0.7）cm2。两组基线资料的比较差异均无统计学意义（均P 〉 0.05）。两组患者均顺利完成手术。与传统钉合组相比，单手四针缝合组的手术时间长[（34.2±1.9）min比（30.3±1.1）min，t=5.484，P=0.045]，假疝囊关闭时间长[（4.2±0.5）min比（1.8±0.7）min，t=7.423，P=0.031]，但视觉模拟评分（VAS）低[（3.2±0.1）分比（5.3±0.6）分，t=-3.186，P=0.015]，总体住院费�
Objective To investigate the efficacy of single-hand four-needle suture with sled-shaped needle three-tail fixed stitch in closure of pesudohernia sac of direct hernia under transabdominal preperitoneal （TAPP） inguinal hernia repair. Methods A randomized controlled trail was conducted on adult＇ patients with unilateral direct inguinal hernia undergoing laparoscopic TAPP repair from January 2014 to January 2018 at the Sixth Affiliated Hospital of Sun Yat-sen University. A total of 156 patients were enrolled prospectively in the study and were randomly divided into single- hand four-needle suture group （trial group, 76 cases） and traditional tacking group （control group, 80 cases）. In trial group, sled-shaped needle three-tail knot-free stitch was applied to the continuous four-needle suture. The sled-shaped needle three-tail fixed stitch was made as follows： straighten the tail of a 3-0, 1/2-circle looper VICRYL Rapide into a sled shape; use suture overlap method to make and tighten a single knot; thread the end of the needle into the single knot loop;knot two ends of the thread next to the first knot; tighten the second knot, leaving about 12 cm to the end of the needle;cut the end of the loop （leaving about 0.6 cm） and the other end of the thread （leaving about 1.5 cm）. In the control group, a hernia repair tack was used to fix the pseudohernia sac on pectineal ligament. This study was approved by the Hospital Ethics Committee（approval number： L2014ZSLYEC-016）. Operation time, pseudoherina sac closure time, hospitalization cost, morbidity of postoperative complication, VAS score and postoperative recurrence were compared between two groups. Results All the patients completed operations successfully. There were no significant differences between trial group and control group in age [（60.2-＋0.4） years vs. （61.1-＋0.7） years）], gender （male ratio 93.4% vs. 92.5%）, BMI [ （25.1-＋0.2） kg/m2 vs. （24.9：t0.2） kg/m2], defection area [ （16.1-＋0.4） cm2 vs. （
作者
周太成
马宁
于洪燕
江志鹏
李英儒
甘文昌
侯泽辉
陈双
Zhou Taicheng;Ma Ning;Yu Hongyan;Jiang Zhipeng;Li Yingru;Gan Wenchang;Hou Zehui;Chen Shuang(Department of Gastroenterological and Hernia Surgery, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, China)
出处
《中华胃肠外科杂志》
CAS
CSCD
北大核心
2018年第7期749-754,共6页
Chinese Journal of Gastrointestinal Surgery
基金
广东省科技计划项目（2017A020215036）
广州市科技计划项目（201806020036）
关键词
腹腔镜
直疝假疝囊
经腹腔腹膜前疝修补术
单手四针缝合
Laparoscopy
Pseudoherinia sac of direct hernia
Transabdominal preperitoneal inguinal hernia repair
Single-hand four-needle suture
