后腹腔镜手术两种切口方法损伤肋下神经的对照研究

Comparative study on subcostal nerve injury between two incision methods in retroperitoneoscopic surgery

摘要:

目的 比较后腹腔镜手术两种切口方法对肋下神经损伤的影响。方法 回顾性分析2022年7月－2024年6月在该院泌尿外科接受后腹腔镜手术治疗的91例患者的临床资料，根据建立后腹腔间隙的第一切口方法不同，将患者分为A组（47例）和B组（44例）。A组以肋脊角为第一切口，B组以腋中线髂棘上方为第一切口。术后随访6～24个月，观察手术侧的肋下神经损伤情况，包括：慢性疼痛、感觉麻木和腹壁隆起发生率。结果 A组肋下神经损伤的总体发生率为55.3%（26/47），明显高于B组的15.9%（7/44），差异有统计学意义（P < 0.01）；其中，A组慢性疼痛的发生率为31.9%（15/47），明显高于B组的9.1%（4/44），差异有统计学意义（P < 0.01）；两组患者神经损伤侧别比较，差异无统计学意义（P > 0.05）。结论 后腹腔镜手术以肋脊角为第一切口时，具有较高的肋下神经损伤风险。

Abstract:

Objective To compare the effects of subcostal nerve injury between two incision methods in retroperitoneoscopic surgery.Methods A retrospective analysis was conducted on the clinical data of 91 patients who underwent retroperitoneal laparoscopic surgery in the Department of Urology of this hospital from July 2022 to June 2024. The patients were divided into group A (47 cases) and group B (44 cases) based on the different first opening methods for establishing the retroperitoneal space. In group A, the costovertebra angle was the first incision, while in group B, the midaxillary line above the iliac spine was the first incision. The patients were followed up for 6 to 24 months after the operation to observe the injury of the subcostal nerve on the surgical side, including the incidence of chronic pain, sensory numbness and abdominal wall bulge.Results The overall incidence of subcostal nerve injury in group A was 55.3% (26/47), significantly higher than 15.9% (7/44) in group B, and the difference was statistically significant (P < 0.01). Among them, the incidence of chronic pain in group A was 31.9% (15/47), which was significantly higher than 9.1% (4/44) in group B, and the difference was statistically significant (P < 0.01). There was no statistically significant difference in the side of nerve injury between the two groups of patients (P > 0.05).Conclusion When retroperitoneal laparoscopic surgery uses the costovertebra angle as the first incision, there is relatively high risk of subcostal nerve injury.