摘要
目的:探讨斜疝疝囊T形切开法对腹腔镜经腹腹膜前疝修补术(TAPP)学习曲线的影响及临床应用价值。方法:回顾分析2021年11月至2024年6月接受同一初学者采用疝囊T形切开法为24例腹股沟斜疝患者(28例次)施行TAPP的临床资料。记录手术时间,应用累积和法获得学习曲线;通过比较学习曲线前后两阶段的总手术时间、各步骤手术时间等指标验证并分析学习曲线。结果:总体学习曲线在第15例次出现拐点,第16~20例次出现平台期。熟练组总手术时间[72.00(53.50,91.00)min vs.105.00(100.00,125.00)min]、切开腹膜与游离腹膜前间隙时间[(13.46±2.15)min vs.(19.13±3.46)min]、分离疝囊时间[(24.38±9.84)min vs.(41.00±4.16)min]、修整腹膜前间隙与放置补片时间[(16.46±5.72)min vs.(30.33±6.91)min]、缝合腹膜时间[17.00(15.00,19.00)min vs.22.00(18.00,28.00)min]均短于学习组,差异有统计学意义(P<0.05);两组一般资料、术中出血量、术后并发症发生率、术后住院时间差异无统计学意义(P>0.05);两组均无中转开腹及疝复发。结论:在上级医师指导下,初学者采用疝囊T形切开法行TAPP的学习曲线约为15例次,其后有约5例次的平台期,此法操作简单、效果确切,可帮助TAPP初学者安全越过学习曲线。
Objective:To investigate the impact of T-shaped incision of the indirect hernia sac on the learning curve of laparoscopic transabdominal preperitoneal hernia repair(TAPP)and its clinical application value.Methods:The clinical data of 24 patients(28 procedures)with indirect inguinal hernia who underwent TAPP with T-shaped incision of hernia sac performed by the same beginner from Nov.2021 to Jun.2024 were retrospectively analyzed.Operation time of each case was recorded,and the learning curve was constructed using the cumulative sum method.The learning curve was verified and analyzed by comparing the total operation time,time for each surgical step,and other indicators between the initial(pre-curve)and proficient(post-curve)phases.Results:The overall learning curve reached an inflection point at the 15th procedure,followed by a plateau phase(procedures 16~20).Total operation time[72.00(53.50,91.00)min vs.105.00(100.00,125.00)min],time of peritoneal incision and preperitoneal space separation[(13.46±2.15)min vs.(19.13±3.46)min],time of hernia sac separation[(24.38±9.84)min vs.(41.00±4.16)min],time of trimming the preperitoneal space and mesh placement[(16.46±5.72)min vs.(30.33±6.91)min],and time of peritoneal closure[17.00(15.00,19.00)min vs.22.00(18.00,28.00)min]in the proficient group were shorter than those in the initial group,the differences were statistically significant(P<0.05).There were no significant differences in baseline characteristics,intraoperative blood loss,postoperative complication incidence or postoperative hospital stay between the two groups(P>0.05).Neither group required conversion to open surgery or experienced hernia recurrence.Conclusions:Under supervision by an senior surgeon,the learning curve of TAPP with T-shaped hernia sac incision performed by beginners is about 15 procedures,with a subsequent 5-procedure plateau phase.This technique is straightforward and effective,enabling novice surgeons to safely overcome the learning curve.
作者
王法宝
褚亮
邓锐
蒋磊
吴卫东
WANG Fabao;CHU Liang;DENG Rui(Department of General Surgery,the Second Affiliated Hospital of Bengbu Medical University,Bengbu 233000,China)
出处
《腹腔镜外科杂志》
2025年第6期454-459,共6页
Journal of Laparoscopic Surgery
关键词
疝
腹股沟
疝修补术
腹腔镜检查
经腹腹膜前
疝囊T形切开
学习曲线
Hernia,inguinal
Herniorrhaphy
Laparoscopy
Transabdominal preperitoneal
T-shaped incision of hernia sac
Learning curve
