疝囊横断法在腹腔镜完全腹膜外疝修补术中对疝囊的处理效果

doi:10.3877/cma.j.issn.1674-392X.2019.03.004

目的

探讨疝囊横断法在腹腔镜完全腹膜外疝修补术（totally extraperitoneal prosthetic，TEP）中的效果。

方法

选取2015年12月至2018年3月，安庆市立医院收治的82例腹股沟疝患者为研究对象，回顾性分析其临床资料。所有患者均行TEP，观察组（40例）术中采用疝囊横断法，对照组（42例）术中完全剥离疝囊，术后定期随访3个月。比较2组手术时间、疝囊剥离时间、术中出血量、术后住院时间及住院费用等，记录术后随访期间2组并发症发生情况。

结果

观察组手术时间、疝囊剥离时间、术后住院时间显著短于对照组，住院费用显著少于对照组，差异均具有统计学意义（P均<0.05），术中出血量、肛门排气时间和术后并发症发生率与对照组比较，差异无统计学意义（P均>0.05）。

结论

疝囊横断法在TEP中的临床效果优于完全剥离疝囊法，可缩短手术时间与疝囊剥离时间，患者术后康复较快。

关键词: 疝，腹股沟, 疝修补术, 腹腔镜, 疝囊横断法, 疗效

Objective

To explore the effect of transection of hernia sac in laparoscopic totally extraperitoneal inguinal hernia repair (TEP).

Methods

82 patients with inguinal hernia treated in Anqing Municipal hospital from December 2015 to March 2018 were selected as the study subjects, and their clinical data were retrospectively analyzed. All patients underwent TEP. The observation group (n=40) was treated with transection of hernia sac during operation, while the control group (n=42) was treated with complete dissection of hernia sac during operation. The two groups were followed up regularly for 3 months after operation. The time of operation, the time of dissection of hernia sac, the amount of intraoperative bleeding, the time of hospitalization and the cost of hospitalization were compared between the two groups; The occurrence of complications in the two groups during the follow-up period were recorded.

Results

The operation time, hernia sac dissection time and hospitalization time after operation in the observation group were significantly shorter than those in the control group, and the hospitalization expenses were significantly less than those in the control group (P<0.05). There was no significant difference in the amount of bleeding during operation and the time of anal exhaust between the two groups (P>0.05); there was no significant difference in the incidence of complications between the two groups (P>0.05).

Conclusion

The clinical effect of transection of hernia sac in TEP is better than that of complete dissection of hernia sac. It can shorten the time of operation and dissection of hernia sac. The patient recovers quickly after operation, so it is worth popularizing and applying.

Key words: Hernia, inguinal, Herniorrhaphy, Laparoscopes, Transection of hernia sac, Effect

表1 2组患者手术相关指标比较（±s）

组别	例数	手术时间(min)	疝囊剥离时间(min)	术中出血量(ml)	术后住院时间(d)	肛门排气时间(h)	住院费用(元)
观察组	40	58.42±5.09	9.57±2.12	8.15±2.20	5.43±2.69	7.40±2.57	7 352.68±550.61
对照组	40	65.75±5.22	24.76±10.08	9.03±3.04	6.30±2.55	7.52±2.65	10 117.14±541.53
P值		<0.05	<0.05	>0.05	<0.05	>0.05	<0.05

表1 2组患者手术相关指标比较（±s）

组别	例数	手术时间(min)	疝囊剥离时间(min)	术中出血量(ml)	术后住院时间(d)	肛门排气时间(h)	住院费用(元)
观察组	40	58.42±5.09	9.57±2.12	8.15±2.20	5.43±2.69	7.40±2.57	7 352.68±550.61
对照组	40	65.75±5.22	24.76±10.08	9.03±3.04	6.30±2.55	7.52±2.65	10 117.14±541.53
P值		<0.05	<0.05	>0.05	<0.05	>0.05	<0.05

表2 2组患者术后并发症发生情况比较

组别	例数	阴囊水肿(例)	阴囊腹股沟区血清肿(例)	慢性疼痛(例)	鞘膜积液(例)	总发生率(%)
观察组	40	2	1	3	0	15.00^a
对照组	42	2	2	5	2	26.19

表2 2组患者术后并发症发生情况比较

组别	例数	阴囊水肿(例)	阴囊腹股沟区血清肿(例)	慢性疼痛(例)	鞘膜积液(例)	总发生率(%)
观察组	40	2	1	3	0	15.00^a
对照组	42	2	2	5	2	26.19

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Analysis of the effect of transection of hernia sac in laparoscopic totally extraperitoneal inguinal hernia repair

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Analysis of the effect of transection of hernia sac in laparoscopic totally extraperitoneal inguinal hernia repair