目的

评估层面分离法（PD）与镜推分离法（TD）在腹腔镜全腹膜外腹股沟疝修补术（TEP）中的安全性与有效性，特别关注手术视野的质量。

方法

回顾性分析2017年1月至2023年10月在广州中医药大学东莞医院和广东医科大学茶山医院接受PD的TEP患者146例（PD组），通过倾向性评分匹配尽量减少混淆因素的影响，在同期手术患者中，按12最优配对匹配TD组292例。主要观察指标包括腹膜损伤、血管损伤、手术视野清晰度、手术时间、术中出血量、术后总并发症和严重并发症发生率，次要观察指标包括住院时间、术后疼痛和复发率等。

结果

倾向性评分匹配后，两组在关键预后因素上均衡，具有可比性。PD组手术视野清晰度Ⅰ级和Ⅳ级优于TD组（χ²=5.310、4.074；P=0.021、0.044），术中出血量少于TD组（t=2.875，P=0.004），且手术时间较短（t=4.484，P＜0.001）。TD组住院费用高于PD组（t=6.869，P＜0.001）。两组在住院时间和随访时间上差异无统计学意义。在总并发症发生率上有显著差异（χ²=6.778，P=0.009），主要是腹膜损伤（χ²=6.665，P=0.010）。虽然TD组中1例出血超过500 ml，1例主动脉损伤，但两组在严重并发症方面差异无统计学意义（χ²=0.501，P=0.479）。此外，两组患者均未发生切口感染和慢性疼痛并发症。

结论

PD与TD在TEP中均展现出有效性与可靠性。PD在手术视野清晰度、减少腹膜损伤方面表现更优，并能缩短手术时间，减少术中出血量和费用支出，在TEP中具备较大的应用潜力。

Objective

To evaluate the safety and efficacy of plane dissection （PD） versus telescopic dissection （TD） in totally extraperitoneal （TEP） laparoscopic hernioplasty， with special focus on the quality of surgical field vision.

Methods

A retrospective analysis was conducted on 146 patients who underwent PD from January 2017 to October 2023 in Dongguan Hospital of Guangzhou University of Chinese Medicine and Chashan Hospital Affiliated to Guangdong Medical University. Propensity score matching （PSM） was used to minimize the impact of confounding factors. Among the patients who received operation at the same period，292 cases were matched with TD group in the optimal proportion of 12. The primary outcomes included peritoneal damage， vascular injury， clarity of surgical field vision， operation time， intraoperative blood loss，and complications. Secondary outcomes were length of hospital stay， postoperative pain， recurrence rate，and so on.

Results

After PSM， the two groups were comparable in terms of key prognostic factors. The PD group had significantly better clarity of surgical field vision compared to the TD group （grade : χ²=5.310，P=0.021； grade: 4.074， P=0.044）， less intraoperative blood loss， and shorter operation time （t=2.875， 4.484；P=0.004， ＜0.001）. The TD group had higher costs than the PD group （t=6.869， P＜0.001）. There were no statistically significant differences between the two groups in terms of length of hospital stay and followup duration. The overall complication rate was significantly different between the two groups （χ²=6.778，P=0.009）， mainly due to differences in peritoneal injuries （χ²=6.665， P=0.010）. Although one case in the TD group had bleeding exceeding 500 ml and one case of aortic injury， there were no statistical differences in severe complications classified by the Clavien-Dindo system between the two groups （χ²=0.501， P=0.479）.Additionally， there were no incisional infections or chronic pain in either group.

Conclusions

Both PD and TD demonstrate effectiveness and reliability in TEP surgery. PD shows superior performance in terms of clarity of surgical field vision， reducing peritoneal injuries， shortening operation time， and reducing intraoperative blood loss and expenses. Therefore， PD has significant potential for application in TEP surgery.