摘要目的:探讨路径规划下腰疝修补术的临床疗效。方法:采用回顾性描述性研究方法。收集2016年11月至2024年3月中国科学技术大学附属第一医院收治的35例腰疝患者的临床资料；男14例，女21例；年龄为（61±8）岁。根据术前CT检查疝缺损大小，疝缺损长径<4 cm患者行增强视野下腹腔镜全腹膜外修补术（eTEP），疝缺损长径为4~8 cm患者行腹腔镜部分腹膜外修补术（TAPE），疝缺损长径>8 cm患者行开放腹膜前补片修补术（Sublay）。正态分布的计量资料以 xˉ±s表示，3组比较采用单因素ANOVA分析或Kruskal-Wallis检验。两两比较采用Bonferroni校正。偏态分布的计量资料以 M（范围）表示。计数资料以绝对数或百分比表示，组间比较采用 χ2检验或Fisher确切概率法。 结果:（1）手术情况。35例患者中，15例行eTEP，男7例、女8例，左侧疝12例、右侧疝3例，手术时间为（92±44）min，术后住院时间为（5.6±2.8）d；17例行TAPE，男5例、女12例，左侧疝9例、右侧疝7例、双侧疝1例，手术时间为（114±56）min，术后住院时间为（6.4±3.0）d；3例行Sublay，男2例、女1例，左侧疝1例、右侧疝2例，手术时间为（150±55）min，术后住院时间为（12.3±7.8）d；3者术后住院时间比较，差异有统计学意义（ F=4.83， P<0.05）。（2）随访情况。35例患者均获得随访，随访时间为40.5（3.0~91.0）个月。35例患者均无浆液肿、切口感染、肠瘘、肠梗阻、戳孔血肿术后并发症，均未出现腰疝复发，行TAPE患者中1例术后发生腹胀，对症治疗后痊愈。行eTEP、TAPE、Sublay患者术后3个月内急性疼痛分别为0、5、2例，3者比较，差异有统计学意义（ χ2=8.69， P<0.05），两两比较，行eTEP和Sublay患者术后3个月内急性疼痛比较，差异有统计学意义（ P<0.05），行eTEP和TAPE患者术后3个月内急性疼痛比较，差异有统计学意义（ P<0.05）；术后3个月后慢性疼痛分别为0、1、1例，3者比较，差异无统计学意义（ χ2=4.00， P>0.05）。 结论:根据患者腰疝缺损长径制订手术方式安全、可行。

abstractsObjective:To investigate the clinical efficiency of lumbar hernia repair based on path planning.Methods:The retrospective and descriptive study was conducted. The clinical data of 35 patients with lumbar hernia who were admitted to The First Affiliated Hospital of University of Science and Technology of China from November 2016 to March 2024 were collected. There were 14 males and 21 females, aged (61±8)years. According to preoperative computerized tomography examination of the hernia defect diameter, patients with a defect diameter <4 cm underwent enhan-ced field laparoscopic total extraperitoneal repair (eTEP), patients with a defect diameter of 4-8 cm underwent laparoscopic partial extraperitoneal repair (TAPE), and patients with a defect diameter >8 cm underwent open preperitoneal mesh repair (Sublay). Measurement data with normal distribu-tion were represented as Mean± SD, and comparison of three groups were conducted using the one-way ANOVA or Kruskal Wallis test, and Bonferroni correction was used for pariwise comparison. Measurement data with skewed distribution were represented as M(range). Count data were descri-bed as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test or Fisher exact probability. Results:(1) Operation conditions. Of 35 patients, there were 15 cases undergoing eTEP, of 7 males and 8 females and 12 cases of left hernia and 3 cases of right hernia, with operation time of (92±44)minutes and the duration of postoperative hospital stay of (5.6±2.8)days. There were 17 cases undergoing TAPE, of 5 males and 12 females and 9 cases of left hernia, 7 cases of right hernia and 1 case of bilateral hernia, with operation time of (114±56)minutes and the duration of postoperative hospital stay of (6.4±3.0) days. There were 3 cases undergoing Sublay, of 2 males and 1 female and 1 case of left hernia and 2 cases of right hernia, with operation time of (150±55)minutes and the duration of postoperative hospital stay of (12.3±7.8)days. There were significant differences in the duration of postoperative hospital stay among the three groups ( F=4.83, P<0.05). (2) Follow-up. All 35 patients were followed up for 40.5(range, 3.0-91.0)days. None of patient underwent postoperative complications such as serous swelling, incision infection, intestinal fistula, intestinal obstruction, or puncture hematoma, and no recurrence of lumbar hernia occurred. One patient who underwent TAPE had postoperative abdominal distension, and was cured by symptomatic treatment. Cases with acute pain within postoperative 3 months were 0, 5, 2 in patients undergoing eTEP, TAPE, Sublay, respectively, showing significant differences among them ( χ2=8.69, P<0.05). Results of pariwise comparison showed that there was a significant difference in acute pain within postoperative 3 months between patients undergoing eTEP and Sublay ( P<0.05), and there was a significant difference in acute pain within postoperative 3 months between patients undergoing eTEP and TAPE ( P<0.05); Cases with chronic pain after postoperative 3 months were 0, 1, 1 in patients undergoing eTEP, TAPE, Sublay, respectively, showing no significant difference among them ( χ2=4.00, P>0.05). Conclusion:It is safe and feasible to formulate the surgical method according to the defect diameter of lumbar hernia.