腹腔镜经腹腹膜前修补术与完全腹膜外修补术治疗腹股沟疝的临床疗效及术后血清肿情况分析

doi:10.3877/cma.j.issn.1674-392X.2019.02.011

目的

探讨腹腔镜经腹腹膜前疝修补术（laparoscopic trans-abdominal preperitoneal hernia repair，TAPP）及腹腔镜完全腹膜外疝修补术（laparoscopic totally extra-peritoneal，TEP）治疗腹股沟疝的疗效及术后血清肿发生率，并分析血清肿发生原因及预防治疗措施。

方法

回顾性分析2017年1月至2018年6月，北京市顺义区医院腹股沟疝75例患者的临床资料，按照术式不同分为TAPP组（45例）及TEP组（30例）。分别监测2组的手术时间、术后住院时间、住院费用等围术期指标及术后血清肿发生情况。

结果

相对于TEP组，TAPP组手术时间明显缩短，差异有统计学意义[（55.50±4.25）min比（65.36±6.52）min，P<0.05]。但TAPP组住院费用高于TEP组，差异有统计学意义[（1.45±0.07）万元比（1.25±0.05）万元，P<0.05]。TAPP组和TEP组术后住院时间比较，差异无统计学意义[（3.25±1.34）d比（3.55±1.20）d，P>0.05]。TAPP组术后血清肿发生率低于TEP组，差异有统计学意义[2.22%（1/45）比13.33%（4/30），P<0.05]。

结论

相对于传统腹股沟疝修补术，TAPP与TEP均具有显著的治疗效果，但TAPP住院费用相对较高。TAPP相对于TEP可降低术后血清肿发生概率。合理的术式选择，准确的术中操作可能是减少术后血清肿发生率的关键。

关键词: 疝，腹股沟, 疝修补术, 腹腔镜, 血清肿，复发

Objective

To explore the difference between laparoscopic transabdominalpreperitoneal hernia repair (TAPP) and laparoscopic totally extra-peritoneal repair (TEP) in the treatment of inguinal hernia and the incidence of postoperative seroma, and to analyze the causes of seroma and preventive treatment measures.

Methods

A retrospective analysis was conducted on 45 TAPP patients with inguinal hernia (TAPP group) and 30 TEP patients with inguinal hernia (TEP group) treated in the hospital of Shunyi District from January 2017 to June 2018. Perioperative indicators such as operation time, postoperative hospitalization time, hospitalization cost, as well as postoperative incidence of seromas in the two groups were monitored respectively.

Results

Compared with TEP group, TAPP group reduced the operative time [(55.50±4.25) minutes vs (65.36±6.52) minutes, P<0.05].However, the hospitalization cost of TAPP group was higher than that of TEP group [(14 500±700) yuan vs (12 500±500) yuan, P<0.05]. Postoperative hospitalization days in the TAPP group and TEP group were (3.25±1.34) and (3.55±1.20) days, respectively, with no statistically significant difference (P>0.05). The incidence of postoperative seroma in TAPPgroup was lower than that in the TEP group (P<0.05).

Conclusion

Compared with traditional open inguinal hernia repair, both TAPP and TEP have significant therapeutic effects, but TAPP has a relatively high cost of hospitalization. Compared with TEP, TAPP can reduce the incidence of postoperative seroma. We believe that reasonable patient selection and accurate intraoperative operation may be the key to reduce the incidence of postoperative seroma.

Key words: Hernia, inguinal, Herniorrhaphy, Laparoscopes, Seroma, Recurrence

表1 2组患者术前基本情况比较

组别	例数	年龄(岁, ±s)	性别(女)[例(%)]	斜疝[例(%)]	疝环R>3 cm[例(%)]
TAPP	45	60.20±2.50	2(4.44)	42 (93.33)	10
TEP	30	61.20±3.50	1(3.33)	28(93.33)	8
检验值		t=0.49	χ²=0.06	χ²=0.00	χ²=0.20
P值		>0.05	>0.05	>0.05	>0.05

表1 2组患者术前基本情况比较

组别	例数	年龄(岁, ±s)	性别(女)[例(%)]	斜疝[例(%)]	疝环R>3 cm[例(%)]
TAPP	45	60.20±2.50	2(4.44)	42 (93.33)	10
TEP	30	61.20±3.50	1(3.33)	28(93.33)	8
检验值		t=0.49	χ²=0.06	χ²=0.00	χ²=0.20
P值		>0.05	>0.05	>0.05	>0.05

表2 2组患者围手术期相关指标、住院费用及术后血清肿发生率比较

组别	例数	手术时间(min, ±s)	住院时间(d, ±s)	住院费用(万元, ±s)	血清肿[例(%)]
TAPP	45	55.50±4.25	3.25±1.34	1.45±0.07	1(2.22)
TEP	30	65.36±6.52	3.55±1.20	1.25±0.05	4(13.33)
检验值		t=7.93	t=0.98	t=13.50	χ²=3.57
P		<0.05	>0.05	<0.05	<0.05

表2 2组患者围手术期相关指标、住院费用及术后血清肿发生率比较

组别	例数	手术时间(min, ±s)	住院时间(d, ±s)	住院费用(万元, ±s)	血清肿[例(%)]
TAPP	45	55.50±4.25	3.25±1.34	1.45±0.07	1(2.22)
TEP	30	65.36±6.52	3.55±1.20	1.25±0.05	4(13.33)
检验值		t=7.93	t=0.98	t=13.50	χ²=3.57
P		<0.05	>0.05	<0.05	<0.05

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Clinical effect comparison the of laparoscopic transabdominalpreperitonealhernia repair and laparoscopic totally extra-peritoneal repair in the treatment of inguinal hernia and analysis of the incidence of postoperative seroma

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Clinical effect comparison the of laparoscopic transabdominalpreperitonealhernia repair and laparoscopic totally extra-peritoneal repair in the treatment of inguinal hernia and analysis of the incidence of postoperative seroma