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中华疝和腹壁外科杂志(电子版) ›› 2020, Vol. 14 ›› Issue (05) : 493 -496. doi: 10.3877/cma.j.issn.1674-392X.2020.05.007

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临床论著

腹膜前引流对腹腔镜经腹腹膜前疝修补术患者术后血肿及血清肿的影响
居建明1,†(), 于国锋1   
  1. 1. 215101　江苏省苏州市中西医结合医院普外科
  • 收稿日期:2019-06-15 出版日期:2020-10-20
  • 通信作者: 居建明

Effect of preperitoneal drainage on postoperative hematoma and seroma in patients undergoing laparoscopic transabdominal preperitoneal repair: A prospective randomized controlled study

Jianming Ju1,†(), Guofeng Yu1   

  1. 1. General surgery Department, Suzhou Hospital of Integrated Traditional Chinese and Western Medicine, Suzhou 215101, China
  • Received:2019-06-15 Published:2020-10-20
  • Corresponding author: Jianming Ju
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引用本文：

居建明, 于国锋. 腹膜前引流对腹腔镜经腹腹膜前疝修补术患者术后血肿及血清肿的影响[J]. 中华疝和腹壁外科杂志(电子版), 2020, 14(05): 493-496.

Jianming Ju, Guofeng Yu. Effect of preperitoneal drainage on postoperative hematoma and seroma in patients undergoing laparoscopic transabdominal preperitoneal repair: A prospective randomized controlled study[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2020, 14(05): 493-496.

目的

探讨腹腔镜经腹腹膜前疝修补术（TAPP）放置腹膜前引流对术后血肿及血清肿的影响。

方法

选取2016年6月至2018年5月，江苏省苏州市中西医结合医院收治的单侧腹股沟疝患者90例，随机分为试验组和对照组，2组患者均行TAPP手术。试验组放置腹膜前引流管，对照组不放置引流管。收集2组患者的一般资料、手术相关资料及随访资料进行统计学分析，对比2组患者术后血肿及血清肿发生率差异。

结果

全部患者均完成手术及随访。2组患者的一般资料、疝位置、疝分型、手术时间、住院花费、术后住院时间差异无统计学意义（P>0.05）。2组患者的术后发热发生率、急性疼痛发生率差异无统计学意义（P>0.05）。试验组术后血肿发生率明显低于对照组（P<0.05），试验组患者术后1和3个月血清肿发生率明显低于对照组，差异有统计学意义（P<0.05）。2组患者1年随访均观察到1例复发的病例，差异无统计学意义（P>0.05）；随访期内2组患者均未出现感染的病例。

结论

TAPP中，放置腹膜前引流管能够有效降低患者术后血肿和血清肿的发生率，同时并不增加感染和复发风险。

关键词: 疝, 腹股沟, 腹腔镜, 引流, 血肿, 血清肿
Objective

To investigate the effect of peritoneal drainage in laparoscopic transabdominal preperitoneal hernia repair for postoperative hematoma and seroma.

Methods

A total of 90 patients with unilateral inguinal hernia admitted to Suzhou hospital of integrated traditional Chinese and Western medicine from June 2016 to May 2018 were selected and randomly divided into experimental group and control group. Both groups underwent TAPP surgery. Preperitoneal drainage tube was placed in the experimental group, while no drainage tube was placed in the control group. The general data, operative related data and follow-up data of the two groups were collected for statistical analysis, and the incidence of postoperative hematoma and seroma was compared between the two groups.

Results

Surgery and follow-up were completed in all patients, and the follow-up rate was 100%. There were no statistically significant differences between the two groups in general data, hernia location, hernia type, operation time, hospitalization cost, and postoperative hospitalization time (P>0.05). There was no statistically significant difference between the two groups in the incidence of postoperative fever and acute pain (P>0.05). The incidence of postoperative hematoma in the experimental group was significantly lower than that in the control group (P<0.05), and the incidence of postoperative seroma in the experimental group was significantly lower than that in the control group at 1 month and 3 months after surgery (P<0.05), with statistically significant differences. One case of recurrence was observed in both groups during 1-year follow-up, and the difference was not statistically significant. There was no case of infection in both groups during the follow-up period.

Conclusion

During laparoscopic transabdominal preperitoneal repair, the placement of a preperitoneal drainage tube can effectively reduce the incidence of postoperative hematoma and seroma without increasing the risk of infection and recurrence.

Key words: Hernia, inguinal, Laparoscope, Drainage, Hematoma, Seroma
图1 腹膜前间隙放置引流管
表1 2组患者的一般资料对比
组别 例数 性别[例(%)] 年龄(岁, ±s) 体质量指数(kg/m2, ±s) 疝位置[例(%)] 疝分型[例(%)]
男性 女性 左 右 Ⅱ型 Ⅲ型
试验组 45 42(93.33) 3(6.67) 48.71±15.33 19.39±3.01 17(37.78) 28(62.22) 11(24.44) 34(75.56)
对照组 45 41(91.11) 4(8.89) 46.06±13.97 18.77±2.94 19(42.22) 26(57.78) 14(31.11) 31(68.89)
检验值   3.876* -0.119 1.173 4.129* 2.777*
P值   0.377 0.813 0.453 0.589 0.436
表2 2组患者住院相关资料对比（±s）
组别 例数 手术时间(min) 住院花费(元) 术后住院时间(d)
试验组 45 56.78±9.77 9977.34 4.39±1.78
对照组 45 54.65±8.86 9643.28 4.11±1.84
t值   1.102 1.577 0.938
P值   0.303 0.239 0.322
表3 2组患者并发症情况对比[例（%）]
组别 例数 发热 急性疼痛 血肿 血清肿 复发 感染
术后1个月 术后3个月
试验组 45 5(11.11) 4(8.89) 1(2.22) 5(11.11) 2(4.44) 1(2.22) 0
对照组 45 7(15.56) 3(6.67) 8(17.78) 17(37.78) 11(24.44) 1(2.22) 0
χ2值   1.426 2.347 10.113 21.732 18.332 - -
P值   0.209 0.331 0.001 <0.001 <0.001 - -
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