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中华疝和腹壁外科杂志(电子版) ›› 2018, Vol. 12 ›› Issue (06) : 431 -435. doi: 10.3877/cma.j.issn.1674-392X.2018.06.009

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论著

县级医院开放式无张力疝修补术与腹腔镜疝修补术的临床研究
焦传东1,(), 张子宏1, 张祥志1   
  1. 1. 054800 河北邢台,清河县中心医院
  • 收稿日期:2018-05-02 出版日期:2018-12-18
  • 通信作者: 焦传东

Retrospective study of effect between open tension-free inguinal hernia repair and laparoscopic inguinal hernia repair in country-level hospital

Chuandong Jiao1,(), Zihong Zhang1, Xiangzhi Zhang1   

  1. 1. Qinghe County Central Hospital, Hebei 054800, China
  • Received:2018-05-02 Published:2018-12-18
  • Corresponding author: Chuandong Jiao
  • About author:
    Corresponding author: Jiao Chuandong, Email:
引用本文:

焦传东, 张子宏, 张祥志. 县级医院开放式无张力疝修补术与腹腔镜疝修补术的临床研究[J/OL]. 中华疝和腹壁外科杂志(电子版), 2018, 12(06): 431-435.

Chuandong Jiao, Zihong Zhang, Xiangzhi Zhang. Retrospective study of effect between open tension-free inguinal hernia repair and laparoscopic inguinal hernia repair in country-level hospital[J/OL]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2018, 12(06): 431-435.

目的

探讨开放无张力修补术与腹腔镜疝修补术在县级医院应用中的临床效果。

方法

回顾性分析2016年1月至2017年12月,清河县中心医院连续收治的行成人腹股沟疝手术218例患者的临床资料,分为开放组(Lichtenstein无张力疝修补术)102例,腹腔镜下腹股沟疝修补术(laparoscopic trans-abdominal preperitoneal hernia repair,TAPP)组116例。统计2组患者一般资料、手术资料、术后并发症等方面数据,并进行对比分析。

结果

患者中位数随访时间为651 d,开放组和TAPP组均未出现感染或复发的病例。开放组与TAPP组尿潴留发生率分别为7例(6.9%)、8例(6.9%),差异无统计学意义(P=0.799);开放组术后出现血清肿情况12例(11.8%)、TAPP组25例(21.6%),差异有统计学意义(P=0.042);开放组应用止痛药物情况25例(24.5%)、TAPP组4例(3.4%),差异有统计学意义(P=0.009);恢复日常活动中位数时间均为4 d,差异有统计学意义(P=0.026);开放组中位数手术时间为50 min、TAPP组70 min,差异有统计学意义(P<0.001);开放组住院中位数花费为4 225元、TAPP组为7 425元,差异有统计学意义(P<0.001);开放组无慢性疼痛发生,TAPP组发生慢性疼痛2例(2.0%),差异有统计学意义(P=0.001)。

结论

开放手术和腹腔镜下腹股沟疝修补术在县级医院开展均能取得较好临床效果,但开展腹腔镜疝修补应经过专业培训的基础上,加强同上级医院的联系,谨慎开展。

Objective

To compare clinical effect between open inguinal hernia repair and laparoscopic inguinal hernia repair in country-level hospital.

Methods

A total number of 218 consecutive adult cases with inguinal hernia were analyzed retrospectively from January 2016 to December 2017. The patients were divided into open group performed with Lichtenstein repair (n=102) and laparoscopic group performed with laparoscopic trans-abdominal preperitoneal hernia repair (TAPP, n=116). The clinical data, operation data and complications incidence were analyzed.

Results

The median follow-up time was 651 days. No recurrence or infection case was observed in both 2 groups. The outcome between open group and TAPP group is as follows: postoperative uroschesis occurred in 7 cases (6.9%) and 8 cases (6.9%) respectively without significant difference (P=0.799); seroma occurred in 12 cases (11.8%) and 25 cases (21.5%) with significant difference (P=0.042); analgesics was used in 25 cases (24.5%) and 4 cases (3.4%) with significant difference (P=0.009); the median return-to-work time was both 4 days but with significant difference (P=0.026), the median operation time was 50 and 70 minutes with significant difference (P<0.001); hospital cost was 4 425 and 7 425 yuan with significant difference (P<0.001); chronic pain occurred in 0 and 2 cases (2.0%) with significant difference (P=0.001).

Conclusion

An equal effect between open group and TAPP group was observed. Whereas, it is necessary to undergo professional training and build connection with superior hospital during the initial period.

表1 开放组和腔镜组患者一般情况及术后效果比较
[1]
陈健民,蒋亚男,王殿琛, 等. 河南省太康县腹股沟疝发病状况调查研究[J/CD]. 中华疝和腹壁外科杂志(电子版), 2014,(5): 20-22.
[2]
中华医学会外科学分会疝和腹壁外科学组. 成人腹股沟疝诊疗指南(2014年版)[J]. 中华外科杂志, 2014, 52(7): 484-486.
[3]
陈双,李英儒. 谈腹股沟疝腔镜的腹膜外修补操作技术[J]. 中国普通外科杂志, 2017, 26(10): 1227-1229.
[4]
Koontz AR. History of inguinal-hernia repair[J]. Lancet, 1954, 264(6836): 499-500.
[5]
Lichtenstein IL,Shulman AG,Amid PK, et al. The tension-free hernioplasty[J]. Am J Surg, 1989, 157(2): 188-193.
[6]
Leblanc K, Ger R. Evolution of laparoscopic hernia repair∥Abdominal Wall Hernias[M]. New York: Springer, 2001: 33-36.
[7]
Bittner R,Schmedt CG,Schwarz J, et al. Laparoscopic transperitoneal procedure for routine repair of groin hernia. [J]. BJS, 2002, 89(8): 1062-1066.
[8]
Bökeler U,Schwarz J,Bittner R, et al. Teaching and training in laparoscopic inguinal hernia repair(TAPP): impact of the learning curve on patient outcome[J]. Surg Endosc, 2013, 27(8): 2886-2893.
[9]
Bittner R,Arregui ME,Bisgaard T, et al. Guidelines for laparoscopic (TAPP) and endoscopic(TEP) treatment of inguinal Hernia [International Endohernia Society(IEHS)][J]. Surg Endosc, 2012, 26(8): 2394-2395.
[10]
Group HS. International guidelines for groin hernia management[J]. Hernia, 2018, 22(1): 1-165.
[11]
Simons MP,Aufenacker T,Bay-Nielsen M, et al. European Hernia Society guidelines on the treatment of inguinal hernia in adult patients[J]. Hernia, 2014, 18(3): 443-444.
[12]
Mccormack K,Scott N,Go PM, et al. Laparoscopic techniques versus open techniques for inguinal hernia repair[J]. Cochrane Database Syst Rev, 2003, 1(1): CD001785.
[13]
Schmedt CG,Sauerland S,Bittner R. Comparison of endoscopic procedures vs Lichtenstein and other open mesh techniques for inguinal hernia repair: a meta-analysis of randomized controlled trials[J]. Surg Endosc, 2005, 19(2): 188-199.
[14]
Saber A,Hokkam EN,Ellabban GM. Laparoscopic transabdominal preperitoneal approach for recurrent inguinal hernia: A randomized trial[J]. J Minim Access Surg, 2015, 11(2): 123-128.
[15]
Bay-Nielsen M,Thomsen H,Andersen FH, et al. Convalescence after inguinal herniorrhaphy[J]. Br J Surg, 2010, 91(3): 362-367.
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