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中华疝和腹壁外科杂志(电子版)

中华疝和腹壁外科杂志(电子版) ›› 2019, Vol. 13 ›› Issue (02) : 157 -161. doi: 10.3877/cma.j.issn.1674-392X.2019.02.015

所属专题： 文献；

论著

腹腔镜疝修补术中网片是否固定与开放式无张力疝修补术的疗效比较
钟广俊1,†()   
  1. 1. 225800　江苏扬州，宝应县人民医院普外科
  • 收稿日期:2018-05-25 出版日期:2019-04-18
  • 通信作者: 钟广俊

Comparison of efficacy of laparoscopic herniorrhaphy with or without mesh fixation and open tension-free herniorrhaphy

Guangjun Zhong1,†()   

  1. 1. Department of General Surgery, Baoying County People's Hospital, Yangzhou 225800, China
  • Received:2018-05-25 Published:2019-04-18
  • Corresponding author: Guangjun Zhong
  • About author:
    Corresponding author: Zhong Guangjun, Email:
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钟广俊. 腹腔镜疝修补术中网片是否固定与开放式无张力疝修补术的疗效比较[J]. 中华疝和腹壁外科杂志(电子版), 2019, 13(02): 157-161.

Guangjun Zhong. Comparison of efficacy of laparoscopic herniorrhaphy with or without mesh fixation and open tension-free herniorrhaphy[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2019, 13(02): 157-161.

目的

对比腹腔镜疝修补术网片固定、网片免固定与开放式无张力疝修补术治疗腹股沟疝的有效性及安全性，以期为未来腹股沟疝治疗术式的选择提供依据。

方法

回顾性分析2015年1月至2018年1月，宝应县人民医院收治的腹股沟疝93例患者的临床资料，根据手术方法分为3组：A组，腹腔镜疝修补术网片固定（34例）；B组，腹腔镜疝修补术网片免固定组（31例）；C组，开放式无张力疝修补术（28例）。术后随访1年，对比3组患者手术实施情况、术后并发症发生情况及复发率。

结果

B组术中失血量、手术时间、术后下床活动时间、进食时间、疼痛持续时间、住院时间、术后2 d疼痛评分与A组比较，差异无统计学意义（P>0.05）；A、B组术中失血量少于C组，术后下床活动时间、进食时间、疼痛持续时间、住院时间短于C组，术后2 d疼痛评分低于C组，差异有统计学意义（P<0.05）；3组手术时间两两比较，差异无统计学意义（P>0.05）；3组术后并发症发生率、复发率比较，差异均无统计学意义（P>0.05）。

结论

腹腔镜与开放式无张力疝修补术治疗腹股沟疝疗效相当，且患者术后均无较多并发症，安全性均理想。但因腹腔镜手术无需作较大切口，患者受到创伤小，术后恢复快，其应用价值优于开放式手术。腹腔镜术中补片在不固定的情况下仍能获得与补片固定后相似的效果，故腹腔镜网片免固定疝修补术操作简单，并发症少，临床推广价值更高。

关键词: 腹腔镜疝修补术, 网片固定, 开放式无张力疝修补术
Objective

To compare the effectiveness and safety of laparoscopic herniorrhaphy with or without mesh fixation and open tension-free herniorrhaphy in treatment of inguinal hernia, and to provide a basis for the choice of future inguinal hernia repair.

Methods

The clinical data of 93 cases of inguinal hernia in the Baoying County people's hospital from January 2015 to January 2018 were retrospectively analyzed. All the patients were divided into three groups by surgical procedures, group A: laparoscopic herniorrhaphy with mesh fixation (n=34), group B: laparoscopic herniorrhaphy without mesh fixation (n=31), group C: open tension-free herniorrhaphy (n=28). After 1-year postoperative follow-up, the surgical conditions, postoperative complications and recurrence rate were compared among the three groups.

Results

There were no statistical differences in the intraoperative bleeding volume, operation time, postoperative leaving bed time, feeding time, duration of pain, hospital stays and postoperative 2 d pain score between group B and group A (P>0.05); The intraoperative bleeding volume in group A and group B was less than that in group C; the postoperative leaving bed time, feeding time, duration of pain and hospital stays in group A and group B were shorter than those in group C; the postoperative 2 d pain score in group A and group B was lower than that in group C (P<0.05); There was no statistical difference in the operation time among the three groups (P>0.05); There was no statistical difference in the incidence of postoperative complications and recurrence rate among group A, B and C (P>0.05).

Conclusion

The efficacy of laparoscopic herniorrhaphy and open tension-free herniorrhaphy in the treatment of inguinal hernia are similar. All of them have satisfactory safety with less complications. However, because laparoscopic surgery does not require a large incision, the patients suffer less trauma and achieve rapid postoperative recovery, whose application value is superior to open surgery. The laparoscopic herniorrhaphy without mesh fixation can still obtain similar effects compared with laparoscopic herniorrhaphy with mesh fixation, so that laparoscopic herniorrhaphy without mesh fixation is simple in operation and less in complications, which has higher clinical promotional value.

Key words: Laparoscopic herniorrhaphy, Mesh fixation, Open tension-free herniorrhaphy
表1 3组患者手术情况比较（±s）
组别 例数 术中失血量(mL) 手术时间(min) 术后下床活动时间(d) 进食时间(h) 疼痛持续时间(d) 住院时间(d) 术后2 d疼痛评分(分)
A组 34 4.76±2.48 50.12±20.28 4.09±1.85 8.02±4.56 1.47±0.52 3.11±1.57 2.27±0.71
B组 31 4.12±2.34 48.66±16.33 3.68±1.54 7.28±1.53 1.51±0.57 2.79±1.78 2.29±0.77
C组 28 8.27±3.00 47.02±15.90 20.11±3.23 13.39±5.23 2.54±0.89 6.01±2.53 2.74±0.92
F值 20.198 0.245 466.850 18.913 21.153 21.960 2.987
P值 0.000 0.783 0.000 0.000 0.000 0.000 0.041
t1 1.051 0.318 0.966 0.860 0.296 0.770 0.109
P1 0.149 0.376 0.169 0.197 0.384 0.222 0.458
t2 5.955 0.390 25.329 6.222 5.346 5.697 2.135
P2 0.000 0.349 0.000 0.000 0.000 0.000 0.019
t3 5.045 0.659 24.477 4.905 5.899 5.521 2.209
P3 0.000 0.256 0.000 0.000 0.000 0.000 0.016
表2 3组患者术后并发症及随访1年后复发情况比较[例（%）]
组别 例数 切口感染 切口血肿 血清肿 尿潴留 肠黏连 合计 复发
A组 34 0 0 0 3(8.82) 1(2.94) 4(11.76) 0
B组 31 0 0 0 3(9.68) 0 3(9.68) 0
C组 28 1(3.57) 1(3.57) 0 2(7.14) 0 4(14.29) 2(7.14)
χ2值 - - - - - 0.300 4.745
P值 - - - - - 0.861 0.093
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