探讨腹腔镜经腹腹膜前疝修补术与腹腔镜完全腹膜外疝修补术治疗网塞型补片修补术后复发腹股沟疝患者的临床疗效。

选取2012年3月至2018年4月，苏州高新区人民医院普外科行网塞型补片修补术治疗后复发169例腹股沟疝患者为研究对象。通过查随机数表分为经腹膜组和全腹膜外组。经腹膜组再次行腹膜疝修补术，98例；全腹膜外组再次行全腹膜外修补术，71例。比较2组患者的手术相关指标、术后急慢性疼痛视觉模拟评分法（VAS）评分、并发症和复发情况。手术时间、术中出血量、VAS等为计量资料，使用均数±标准差（±s）来表示，组间比较使用独立样本t检验。复发情况、不良反应情况等情况为计数资料，以率表示，用χ²检验进行比较。

经腹膜组和全腹膜外组患者术后手术时间分别为（41.14±7.54）min、（42.53±4.55）min，差异无统计学意义（P>0.05）；全腹膜外组在术中出血量和术后住院时间分别为（15.14±4.51）ml、（6.70±1.50）min，与经腹膜组（12.94±4.08）ml、（5.10±1.30）min比较，差异有统计学意义（P<0.05）。全腹膜外组患者术后1、7、15和30 d后的VAS评分分别为（6.81±1.90）、（5.74±1.70）、（4.45±1.81）、（3.35±0.63）分，均低于经腹膜组（7.49±1.23）、（6.68±1.31）、（6.22±2.19）、（5.42±1.33）分，差异有统计学意义（P<0.05）。全腹膜外组复发率为0.70%，明显低于经腹膜组的4.59%，差异有统计学意义（P<0.05）。术后2组并发症血清肿、尿潴留、切口及阴囊水肿、切口感染指标比较，差异无统计学意义（P>0.05）；经腹膜组神经感觉异常13例（13.27%）明显高于全腹膜外组3例（4.23%），差异有统计学意义（P<0.05）。

相较经腹膜疝修补术，腹腔镜下全腹膜外疝修补术治疗网塞型补片修补术后复发疝，术中出血小，术后恢复快，可有效缓解术后急慢性疼痛，神经感觉异常发生率及复发率低，具有临床应用优势。

To explore the effect of using laparoscopic total extraperitoneal (TEP) and transabdominal peritoneal (TAPP) hernia repair on in patients with recurrent hernia after mesh plug repair.

Between March 2012 and April 2018, 169 patients with recurrent hernia who had relapsed after the repair of mesh plug in Suzhou Hi-tech Zone People's Hospital were selected as subjects. The laparoscopic hernia repair (total extraperitoneal or transabdominal preperitoneal hernia repair) was performed, and patient data were collected retrospectively. According to the random number table, they were divided into the TAPP group (n=98) and the TEP group (n=71). The postoperative acute and chronic pain visual analogue scale (VAS), complications and recurrence were compared between the two groups. The operation time, intraoperative bleeding volume, VAS, etc., were measured as (±s), independent samples were used t test for comparison between groups. The recurrence, adverse reactions, etc., as the count data, expressed as the rate, compared with the χ² test.

There was no significant difference in operation time between the two groups, but the amount of bleeding and postoperative hospital stay in the TEP group were significantly lower than those in the TAPP group (P<0.05). 1 day, 7 days, 15 days and 30 days after operation, the scores of VAS in the TEP group were lower than those in the TAPP group and the difference was statistically significant (P<0.05). The recurrence rate in the TEP group was 0.70%, which was significantly lower than that in the TAPP group (4.59%, P<0.05). There were no significant differences in seroma, urinary retention, incision and scrotum edema, and wound infection between the two groups (P>0.05). The abnormal nerve sense in the TAPP group was significantly higher than that in the TEP group (P<0.05).

Compared with laparoscopic TAPP repair, the laparoscopic TEP repair for recurrent hernia after mesh plug repair has the advantages of small intraoperative bleeding and fast postoperative recovery, which can effectively relieve postoperative acute and chronic pain, and the incidence and recurrence rate of neurosensory abnormalities are low.