福建医科大学附属泉州第一医院 疝外科，福建 泉州 362000
Department of Hernia Surgery, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, Fujian 362000, China
背景与目的 单孔腹腔镜技术（SILS）目前已被广泛应用于腹部手术中，但在脐疝修补术中的应用鲜见报道。笔者科室在前期成熟开展单孔腹腔镜腹股沟疝修补（TEP）手术的基础上，尝试使用单孔腹腔镜完全腹膜外补片修补术（SIL-TES）治疗成人脐疝并取得一定经验。本文探讨SIL-TES治疗成人脐疝的可行性与疗效。方法 回顾性分析2021年1月—2022年8月福建医科大学附属泉州第一医院疝外科13例行SIL-TES治疗的成人脐疝患者资料，其中，男性9例，女性4例，平均年龄为（38.9±6.1）岁，疝环平均直径（2.4±0.6）cm。SIL-TES的基本要求包括：以三孔腹腔镜完全腹膜外补片修补术为基础，配合单孔腹腔镜的操作技巧，扶镜手与主刀的默契配合，合理放置腹腔镜及器械，尽可能减少操作过程中出现的“筷子”效应；需熟练掌握腹壁的多层解剖，避免术中解剖层次错误、腹膜破损，导致补片不能放置于正确层面。结果 13例均顺利完成手术，无中转开放。手术时间平均（138.5±20.9）min，术后3 d疼痛评分2.5±0.9，术后留置引流管平均（4.1±1.1）d。术后平均住院时间3~6 d，中位时间4.1 d，无术区血清肿、出血、切口裂开、切口感染、脐部皮肤坏死、肠梗阻、肠瘘等并发症。平均随访时间（14.7±6.3）个月，无复发及慢性疼痛等。结论 采用SIL-TES治疗成人脐疝是可行的，可作为成人脐疝的补充手术方式，但碍于病例数少、随访时间短，远期疗效需进一步明确。
Background and Aims Single-incision laparoscopic surgery (SILS) has been widely utilized in abdominal surgeries, but its application in umbilical hernia repair has been limited. Building on the department's prior experience with single-incision laparoscopic inguinal hernia repair (TEP), the authors attempted to treat adult umbilical hernias using single-incision laparoscopic totally extraperitoneal sublay (SIL-TES) and gained certain experience. This study was to explore the feasibility and efficacy of SIL-TES for the treatment of adult umbilical hernia.Methods The data from 13 adult umbilical hernia patients who underwent SIL-TES in Quanzhou First Hospital Affiliated to Fujian Medical University from January 2021 to August 2022 were retrospectively analyzed. Among these patients, there were 9 males and 4 females, with an average age of (38.9±6.1) years and an average hernia ring diameter of (2.4±0.6) cm. The requirements of SIL-TES included: building upon the three-port laparoscopic totally extraperitoneal sublay as the foundation, incorporating the techniques of single-incision laparoscopy, achieving seamless coordination between the camera-holding assistant and the primary surgeon, placing the laparoscope and instruments logically to minimize the "chopstick effect" during the procedure; proficiency in mastering the multi-layer anatomy of the abdominal wall for avoiding intraoperative anatomical errors and peritoneal damage, ensuring the mesh placed in the correct layer.Results All 13 cases were successfully completed without any conversions to open surgery. The average operative time was (138.5±20.9) min, with an average postoperative pain score of 2.5±0.9 at postoperative day 3. The mean duration of postoperative drainage tube placement was (4.1±1.1) d. The average length of postoperative hospital stay was 3 to 6 d, with a median length of 4.1 d. No complications such as seroma, bleeding, wound dehiscence, wound infection, umbilical skin necrosis, bowel obstruction, or bowel fistula occurred. The average follow-up duration was (14.7±6.3) months, and no cases of hernia recurrence or chronic pain occurred.Conclusion The use of SIL-TES for the treatment of adult umbilical hernia is feasible and can serve as a supplementary surgical option. However, due to the limited number of cases and short follow-up duration, the long-term effectiveness of this approach requires further clarification.