标准聚丙烯补片与部分可吸收补片在腹股沟疝腹膜前修补术中的疗效

doi:10.3877/cma.j.issn.1674-392X.2019.04.003

目的

比较标准聚丙烯补片与部分可吸收补片在腹股沟疝腹膜前修补中的差异。

方法

采用前瞻性随机对照的研究方法，对2018年1至9月吉林大学第二医院148例单侧男性腹股沟疝患者随机分为标准聚丙烯补片组（PM组，73例）和部分可吸收补片组（PAM组，75例），分别应用标准聚丙烯补片和部分可吸收补片进行腹膜前腹股沟疝修补术。术后分别观察2组的术后平均住院时间、血清肿、补片感染、术后疼痛、复发、异物感以及治疗费用等相关情况，并应用生活质量评价量表（SF-36）评估其生活质量。

结果

2组患者术后平均住院时间、血清肿发生率、补片感染率、复发率均比较，差异均无统计学意义（P>0.05）；术后6个月疼痛感、局部异物感和治疗费用比较，差异均有统计学意义（P<0.001、0.016 8、<0.001）；2组患者术后SF-36评分比较，差异无统计学意义（P>0.05）。

结论

应用部分可吸收补片可改善患者术后疼痛和异物感的情况，但是需要较高的治疗费用；标准聚丙烯补片与部分可吸收补片均不影响患者术后的生活质量。

关键词: 疝，腹股沟, 疝修补术, 腹膜前, 补片

Objective

To compare the difference in postoperative effects between standard polypropylene (SP) mesh and partial absorbable (PA) mesh in preperitoneal hernioplasty.

Methods

A prospective randomized controlled study was conducted to investigate 148 male patients with unilateral inguinal hernia in the Second Hospital of Jilin University between January 2018 and September 2018. They were randomly divided into two groups: SP mesh group (73 patients) and the PA mesh group (75 patients). A tension-free repair using the preperitoneal hernioplasty technique was performed on all patients. The postoperative hospital stay, seroma, mesh infection, postoperative pain, recurrence, foreign body sensation and hospital cost were compared between the two groups, as well as the patients' quality of life was evaluated by the Medical Outcomes Study Short-Form (SF) 36 questionnaire which was completed by the patient.

Results

No statistical difference was observed for average length of stay, incidence of seroma, mesh infection rate and recurrence rate between the two groups (P>0.05). There were significant differences in pain at 6 months after operation (P<0.001), foreign body sensation (P=0.016 8) and hospital cost (P<0.001) between the two groups. No statistical difference was observed for SF-36 score between the two groups (P>0.05).

Conclusion

Implantation of partial absorbable mesh can ameliorate postoperative pain and foreign sensation but will need more curative cost for patients. Neither of the mesh would affect the quality of patients' life after operation.

Key words: Hernia, inguinal, Hernioplasty, Preperitoneal, Mesh

表1 2组男性单侧腹股沟疝患者术前和术中的一般情况比较

组别	例数	年龄(岁, ±s)	体质量指数(kg/m², ±s)	确诊至手术时间(个月, ±s)	疝类型[例(%)]			缺损直径[例(%)]			麻醉方法[例(%)]			平均手术时间(min, ±s)
组别	例数	年龄(岁, ±s)	体质量指数(kg/m², ±s)	确诊至手术时间(个月, ±s)	直疝	斜疝	马鞍疝	<1.5 cm	1.5~3 cm	>3 cm	硬膜外	全麻	局麻	平均手术时间(min, ±s)
PM组	73	55.4±6.5	23.4±1.7	25.8±7.9	7(9.59)	61(83.56)	5(6.85)	15(20.55)	48(65.75)	10(13.70)	64(87.67)	6(8.22)	3(4.11)	38±11
PAM组	75	53.7±4.7	23.0±1.6	28.3±8.8	6(8.00)	64(85.33)	5(6.67)	18(24.00)	49(65.33)	8(10.67)	68(90.67)	3(4.00)	4(5.33)	41±9
F值	?	1.820	1.470	-1.820	-			0.478			-			-1.820
P值	?	0.071	0.142	0.071	0.943			0.787			0.622			0.071

表1 2组男性单侧腹股沟疝患者术前和术中的一般情况比较

组别	例数	年龄(岁, ±s)	体质量指数(kg/m², ±s)	确诊至手术时间(个月, ±s)	疝类型[例(%)]			缺损直径[例(%)]			麻醉方法[例(%)]			平均手术时间(min, ±s)
组别	例数	年龄(岁, ±s)	体质量指数(kg/m², ±s)	确诊至手术时间(个月, ±s)	直疝	斜疝	马鞍疝	<1.5 cm	1.5~3 cm	>3 cm	硬膜外	全麻	局麻	平均手术时间(min, ±s)
PM组	73	55.4±6.5	23.4±1.7	25.8±7.9	7(9.59)	61(83.56)	5(6.85)	15(20.55)	48(65.75)	10(13.70)	64(87.67)	6(8.22)	3(4.11)	38±11
PAM组	75	53.7±4.7	23.0±1.6	28.3±8.8	6(8.00)	64(85.33)	5(6.67)	18(24.00)	49(65.33)	8(10.67)	68(90.67)	3(4.00)	4(5.33)	41±9
F值	?	1.820	1.470	-1.820	-			0.478			-			-1.820
P值	?	0.071	0.142	0.071	0.943			0.787			0.622			0.071

表2 2组男性单侧腹股沟疝患者术后相关指标比较

组别	例数	术后住院时间(d, ±s)	术后7 d血清肿(例)	术后6个月补片感染(例)	VAS疼痛评分(分, ±s)				术后6个月复发(例)	术后6个月局部不适或异物感(例)	治疗费用(元, ±s)
组别	例数	术后住院时间(d, ±s)	术后7 d血清肿(例)	术后6个月补片感染(例)	术前	术后7 d	术后1个月	术后6个月	术后6个月复发(例)	术后6个月局部不适或异物感(例)	治疗费用(元, ±s)
PM组	73	2.25±0.77	6	0	0.14±0.03	0.31±0.08	0.21±0.06	0.07±0.01	0	8	7 322±129
PAM组	75	2.37±0.81	4	0	0.15±0.04	0.33±0.11	0.19±0.07	0.05±0.01	0	1	8 547±156
F值	?	-0.920	-	-	-1.720	-1.270	1.860	12.160	-	-	-51.990
P值	?	0.357	0.530^a	-	0.081	0.207	0.064	<0.001	-	0.017^a	<0.001

表2 2组男性单侧腹股沟疝患者术后相关指标比较

组别	例数	术后住院时间(d, ±s)	术后7 d血清肿(例)	术后6个月补片感染(例)	VAS疼痛评分(分, ±s)				术后6个月复发(例)	术后6个月局部不适或异物感(例)	治疗费用(元, ±s)
组别	例数	术后住院时间(d, ±s)	术后7 d血清肿(例)	术后6个月补片感染(例)	术前	术后7 d	术后1个月	术后6个月	术后6个月复发(例)	术后6个月局部不适或异物感(例)	治疗费用(元, ±s)
PM组	73	2.25±0.77	6	0	0.14±0.03	0.31±0.08	0.21±0.06	0.07±0.01	0	8	7 322±129
PAM组	75	2.37±0.81	4	0	0.15±0.04	0.33±0.11	0.19±0.07	0.05±0.01	0	1	8 547±156
F值	?	-0.920	-	-	-1.720	-1.270	1.860	12.160	-	-	-51.990
P值	?	0.357	0.530^a	-	0.081	0.207	0.064	<0.001	-	0.017^a	<0.001

表3 2组男性单侧腹股沟疝患者生活质量评价量表比较（分，±s）

SF-36评分	一般健康状况		活力		躯体疼痛		精神健康
SF-36评分	PM(73例)	PAM(75例)	PM(73例)	PAM(75例)	PM(73例)	PAM(75例)	PM(73例)	PAM(75例)
术前	63.77±4.55	63.45±3.76	66.25±5.53	67.55±6.78	68.75±5.85	65.01±7.89	78.21±6.55	77.95±8.68
术后6个月	64.98±5.41	64.21±4.21	71.17±6.55	70.28±7.01	78.23±8.78	80.15±9.55	80.25±7.54	81.06±6.68
F值	-1.460	-1.170	-4.900	-2.420	-7.680	-10.580	-1.750	-2.460
P值	0.146^a	0.246^a	<0.001^a	0.016^a	<0.001^a	<0.001^a	0.083^a	0.015^a
F值	0.960		0.800		-1.270		-0.690
P值	0.336^b		0.426^b		0.205^b		0.490^b
SF-36评分	社会功能		生理功能		情绪角色		生理角色
SF-36评分	PM(73例)	PAM(75例)	PM(73例)	PAM(75例)	PM(73例)	PAM(75例)	PM(73例)	PAM(75例)
术前	82.75±5.89	83.21±10.21	64.35±5.88	63.89±6.55	65.89±4.68	66.37±5.89	55.74±6.01	48.77±5.85
术后6个月	88.96±7.78	90.33±11.25	87.69±7.41	88.36±8.09	87.65±8.78	86.98±9.55	78.35±8.39	77.67±10.33
F值	-5.440	-4.060	-21.080	-20.360	-18.690	-15.910	-18.720	-21.080
P值	<0.001^a	<0.001^a	<0.001^a	<0.001^a	<0.001^a	<0.001^a	<0.001	<0.001
F值	-0.860		-0.520		0.440		0.440
P值	0.389^b		0.600^b		0.658^b		0.661

表3 2组男性单侧腹股沟疝患者生活质量评价量表比较（分，±s）

SF-36评分	一般健康状况		活力		躯体疼痛		精神健康
SF-36评分	PM(73例)	PAM(75例)	PM(73例)	PAM(75例)	PM(73例)	PAM(75例)	PM(73例)	PAM(75例)
术前	63.77±4.55	63.45±3.76	66.25±5.53	67.55±6.78	68.75±5.85	65.01±7.89	78.21±6.55	77.95±8.68
术后6个月	64.98±5.41	64.21±4.21	71.17±6.55	70.28±7.01	78.23±8.78	80.15±9.55	80.25±7.54	81.06±6.68
F值	-1.460	-1.170	-4.900	-2.420	-7.680	-10.580	-1.750	-2.460
P值	0.146^a	0.246^a	<0.001^a	0.016^a	<0.001^a	<0.001^a	0.083^a	0.015^a
F值	0.960		0.800		-1.270		-0.690
P值	0.336^b		0.426^b		0.205^b		0.490^b
SF-36评分	社会功能		生理功能		情绪角色		生理角色
SF-36评分	PM(73例)	PAM(75例)	PM(73例)	PAM(75例)	PM(73例)	PAM(75例)	PM(73例)	PAM(75例)
术前	82.75±5.89	83.21±10.21	64.35±5.88	63.89±6.55	65.89±4.68	66.37±5.89	55.74±6.01	48.77±5.85
术后6个月	88.96±7.78	90.33±11.25	87.69±7.41	88.36±8.09	87.65±8.78	86.98±9.55	78.35±8.39	77.67±10.33
F值	-5.440	-4.060	-21.080	-20.360	-18.690	-15.910	-18.720	-21.080
P值	<0.001^a	<0.001^a	<0.001^a	<0.001^a	<0.001^a	<0.001^a	<0.001	<0.001
F值	-0.860		-0.520		0.440		0.440
P值	0.389^b		0.600^b		0.658^b		0.661

[1]	Simons MP, Aufenacker T, Bay-Nielsen M, et al. European Hernia Society guidelines on the treatment of inguinal hernia in adult patients[J]. Hernia, 2009, 13(4): 343-403.
[2]	Akolekar D, Kumar S, Khan LR, et al. Comparison of recurrence with lightweight composite polypropylene mesh and heavyweight mesh in laparoscopic totally extraperitoneal inguinal hernia repair: an audit of 1, 232 repairs[J]. Hernia, 2008, 12(1): 39-43.
[3]	Achelrod D, Stargardt T. Cost-utility analysis comparing heavy-weight and light-weight mesh in laparoscopic surgery for unilateral inguinal hernias[J]. Appl Health Econ Health Policy, 2014, 12(2): 151-163.
[4]	Lionetti R, Neola B, Dilillo S, et al. Sutureless hernioplasty with light-weight mesh and fibrin glue versus Lichtenstein procedure: a comparison of outcomes focusing on chronic postoperative pain[J]. Hernia, 2012, 16(2): 127-131.
[5]	陈杰. 实用疝外科手术技巧[M]. 北京: 北京科学技术出版社, 2008: 64.
[6]	Klinge U, Klosterhalfen B, Müller M, et al. Foreign body reaction to meshes used for the repair of abdominal wall hernias[J]. Eur J Surg, 1999, 165(7): 665-673.
[7]	Yang H, Liu Y, Chen J, et al. The management of mesh infection after laparoscopic inguinal hernia repair[J]. Surg Laparosc Endosc Percutan Tech, 2019, 29(1): 40-42.
[8]	Koyama M, Miyagawa Y, Yamamoto Y, et al. Surgery for chronic mesh infection occurred 10 years after sacrectomy - Mesh resection and mesentric leaf repair: A case report[J]. Int J Surg Case Rep, 2017, 30: 215-217.
[9]	Nikkolo C, Lepner U, Murruste M, et al. Randomised clinical trial comparing lightweight mesh with heavyweight mesh for inguinal hernioplasty[J]. Hernia, 2010, 14(3): 253-258.
[10]	Rutegård M, Gümüsçü R, Stylianidis G, et al. Chronic pain, discomfort, quality of life and impact on sex life after open inguinal hernia mesh repair: an expertise-based randomized clinical trial comparing lightweight and heavyweight mesh[J]. Hernia, 2018, 22(3): 411-418.
[11]	Śmietański M, Śmietańska IA, Modrzejewski A, et al. Systematic review and meta-analysis on heavy and lightweight polypropylene mesh in Lichtenstein inguinal hernioplasty[J]. Hernia, 2012, 16(5): 519-528.
[12]	Smietański M, Bury K, Smietańska IA, et al. Five-year results of a randomised controlled multi-centre study comparing heavy-weight knitted versus low-weight, non-woven polypropylene implants in Lichtenstein hernioplasty[J]. Hernia, 2011, 15(5): 495-501.
[13]	Wang D, Chen J, Chen Y, et al. Prospective Analysis of Epigastric, Umbilical, and Small Incisional Hernia Repair Using the Modified Kugel Oval Patch[J]. Am Surg, 2018, 84(2): 305-308.
[14]	Okinaga K, Hori T, Inaba T, et al. A randomized clinical study on postoperative pain comparing the Polysoft patch to the modified Kugel patch for transinguinal preperitoneal inguinal hernia repair[J]. Surg Today, 2016, 46(6): 691-698.
[15]	Classification of chronic pain. Descriptions of chronic pain syndromes and definitions of pain terms. Prepared by the International Association for the Study of Pain, Subcommittee on Taxonomy[J]. Pain Suppl, 1986, 3: S1-S226.

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Comparative study of standard and partial absorbable polypropylene mesh in preperitoneal hernioplasty

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Comparative study of standard and partial absorbable polypropylene mesh in preperitoneal hernioplasty