CAJ | 학술논문

目的：对比研究在腹腔镜下腹股沟疝全腹膜外网片修补术（ total extraperitoneal pros-thetic，TEP）中使用超声刀（ ultracision-harmonic scalpel，UHS）及电外科器械的优、缺点，总结TEP术中应用超声刀的临床体会。方法对比100例TEP患者术中应用超声刀及电外科器械，其中应用超声刀57例（Ⅰ组），电外科器械43例（Ⅱ组）。结果100例患者（133侧）TEP手术均顺利完成，无1例中转采用其他术式。Ⅰ组住院费用0.6~1.4万元，平均1.0万元，单侧手术用时13.6~22.4 min，平均18 min，双侧手术用时27.2~32.8 min，平均30 min；Ⅱ组住院费用0.6~1.2万元，平均0.9万元，单侧手术用时23.3~36.7 min，平均30 min，双侧手术用时50.7~59.3 min，平均55 min。Ⅰ组无腹膜破裂，无术后阴囊血清肿及术后血肿；Ⅱ组腹膜破裂4例，术后阴囊血清肿3例，术后血肿1例。通过电话随访1~24个月，两组均无复发。结论 TEP术中应用超声刀优点突出，可缩短手术时间，减少术中、术后并发症。
목적：대비연구재복강경하복고구산전복막외망편수보술（ total extraperitoneal pros-thetic，TEP）중사용초성도（ ultracision-harmonic scalpel，UHS）급전외과기계적우、결점，총결TEP술중응용초성도적림상체회。방법대비100례TEP환자술중응용초성도급전외과기계，기중응용초성도57례（Ⅰ조），전외과기계43례（Ⅱ조）。결과100례환자（133측）TEP수술균순리완성，무1례중전채용기타술식。Ⅰ조주원비용0.6~1.4만원，평균1.0만원，단측수술용시13.6~22.4 min，평균18 min，쌍측수술용시27.2~32.8 min，평균30 min；Ⅱ조주원비용0.6~1.2만원，평균0.9만원，단측수술용시23.3~36.7 min，평균30 min，쌍측수술용시50.7~59.3 min，평균55 min。Ⅰ조무복막파렬，무술후음낭혈청종급술후혈종；Ⅱ조복막파렬4례，술후음낭혈청종3례，술후혈종1례。통과전화수방1~24개월，량조균무복발。결론 TEP술중응용초성도우점돌출，가축단수술시간，감소술중、술후병발증。
Objective To compare the merits and drawbacks of operating ultracision-harmonic scalpel( UHS)and electrosurgical unit( ESU )in laparoscopic total extraperitoneal prosthetic( TEP )and summarize the clinical experience of operating ultrasonic knife in TEP. Methods A total of 100 TEP pa-tients were treated,including 57 cases( Group Ⅰ)with the ultrasonic knife and 43 cases with the ESU ( GroupⅡ). Results TEP was successfully completed in all 100 cases( 133 sides ). In Group Ⅰ,the mean hospitalization expense was 10 000 yuan( range,6000~14 000 yuan),mean unilateral operation du-ration was 18 min(range,13. 6~22. 4 min),and mean bilateral operation duration was 30min(range,27. 2~32. 8 min);in GroupⅡ,the mean hospitalization time was 9000 yuan( range,6000~12 000 yuan),mean unilateral operation duration was 30 min(range,23. 3~36. 7 min),mean bilateral operation duration was 55 min(range,50. 7 ~59. 3 min). No peritoneal rupture,postoperative scrotum seroma or postoperative hematoma was observed in GroupⅠ,while four peritoneal ruptures,three postoperative scrotum seromas and one postoperative hematoma were observed in GroupⅡ. No relapse was noticed via telephone follow-ups varied from 1 to 24 months in either group. Conclusions UHS in TEP has outstanding advantages in decreasing operation time and reducing complications,which is worthy of being spread.