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中华疝和腹壁外科杂志(电子版) ›› 2020, Vol. 14 ›› Issue (06) : 593 -597. doi: 10.3877/cma.j.issn.1674-392X.2020.06.002

所属专题： 文献；

临床论著

TEP与改良Kugel术治疗双侧腹股沟疝的临床效果
陈皆超1, 吴巨钢1, 倪晓春1, 潘春鹏1, 樊啸1, 俞继卫1,†()   
  1. 1. 201999　上海交通大学医学院附属第九人民医院普外科
  • 收稿日期:2019-12-11 出版日期:2020-12-20
  • 通信作者: 俞继卫

Laparoscopic totally extraperitoneal herniorrhaphy versus modified Kugel repair for bilateral inguinal hernias: A comparative study

Jiechao Chen1, Jugang Wu1, Xiaochun Ni1, Chunpeng Pan1, Xiao Fan1, Jiwei Yu1,†()   

  1. 1. Department of General Surgery, the Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 201999, China
  • Received:2019-12-11 Published:2020-12-20
  • Corresponding author: Jiwei Yu
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陈皆超, 吴巨钢, 倪晓春, 潘春鹏, 樊啸, 俞继卫. TEP与改良Kugel术治疗双侧腹股沟疝的临床效果[J]. 中华疝和腹壁外科杂志(电子版), 2020, 14(06): 593-597.

Jiechao Chen, Jugang Wu, Xiaochun Ni, Chunpeng Pan, Xiao Fan, Jiwei Yu. Laparoscopic totally extraperitoneal herniorrhaphy versus modified Kugel repair for bilateral inguinal hernias: A comparative study[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2020, 14(06): 593-597.

目的

分析比较TEP与改良Kugel术治疗双侧腹股沟疝的临床效果及患者生活质量。

方法

选取2012年1月至2017年1月在上海交通大学医学院附属第九人民医院接受手术治疗双侧腹股沟疝患者157例。按照手术方式分为腹腔镜组（TEP组）和开放组（改良Kugel）组。其中，TEP组71例，改良Kugel组86例。分析比较包括2组患者的手术时间、术中出血量、住院时间、术后并发症、术后早期疼痛、慢性疼痛、复发情况和生活质量。采用SPSS 20.0统计学软件进行数据分析。

结果

TEP组手术时间（93.5±10.9）min，改良Kugel组（102.6±9.8）min，差异有统计学意义（P<0.05）。TEP组住院时间（1.05±0.21）d，改良Kugel组（1.52±0.69）d，差异有统计学意义（P<0.05）。TEP组术中出血量（22.1±7.1）ml，改良Kugel组（23.4±6.8）ml，差异无统计学意义（P>0.05）。TEP组术后恢复正常活动时间（8.67±2.32）d，改良Kugel组（9.14±2.40）d，差异无统计学意义（P>0.05）。TEP组术后并发症5（7%），改良Kugel组10例（11.6%），差异无统计学意义（P>0.05）。并发症患者中身体质量指数>27 kg/m2，TEP组1例（20%），改良Kugel组6例（60%），差异无统计学意义（P>0.05）。TEP组慢性疼痛3例（4.2%），改良Kugel组14例（16%），差异有统计学意义（P<0.05）。截止至随访结束，TEP组术后复发0例，改良Kugel组术后复发1例，占约1%；2组无明显差异（P>0.05）。术后1及7 d，2组疼痛视觉模拟评分比较，差异有统计学意义（P<0.05）；术前、术后及12个月比较，差异无统计学意义（P>0.05）。术前、术后1、2、6及12个月2组生活质量量表评分比较，差异均无统计学意义（P>0.05）。

结论

通过TEP治疗双侧腹股沟疝能有效地减少患者的手术时间、住院时间、术后疼痛。

关键词: 疝, 腹股沟, 疝修补术, 腹腔镜, 改良Kugel术
Objective

The aim of this study is to compare the modified Kugel (M-Kugel) repair with laparoscopic totally extraperitoneal herniorrhaphy (TEP) in patients undergoing surgery for bilateral inguinal hernia.

Methods

Clinical data of 157 patients (71 cases in TEP group and 86 cases in M-Kugel group) undergoing herniorrhaphy in Ninth People's Hospital of Shanghai Jiaotong University School of Medicine were analyzed. Outcome parameters included hospital stay, operation time, intraoperative bleeding volume, postoperative complications, immediate postoperative pain and chronic pain, recurrence and quality of life. The SPSS20.0 statistical software was used for data analysis.

Results

The operation time was (93.5±10.9) minutes in the TEP group and (102.6±9.8) minutes in the modified Kugel group, the difference was statistically significant (P<0.05). The length of stay in the TEP group was (1.05±0.21) days, and it was (1.52±0.69) dayd in the modified Kugel group, the difference was statistically significant (P<0.05). Intraoperative blood loss was (22.1±7.1) ml in the TEP group and (23.4±6.8) ml in the modified Kugel group, the difference was not statistically significant (P>0.05). The time to return normal activities after operation was (8.67±2.32) days in the TEP group and (9.14±2.40) days in the modified Kugel group, and there was no significant difference (P>0.05). Postoperative complications were 5 cases (7%) in the TEP group and 10 cases (11.6%) in the modified Kugel group. The difference was not statistically significant (P>0.05). Among the patients with complications, the body mass index was more than 27 kg/m2, there was 1 case (20%) in the TEP group and 6 cases (60%) in the modified Kugel group. The difference was not statistically significant (P>0.05). There were 3 cases of chronic pain (4.2%) in the TEP group and 14 cases (16%) in the modified Kugel group. The difference was statistically significant (P<0.05). As of the end of the follow-up, there was no recurrence in the TEP group and 1 recurrence in the modified Kugel group (about 1%); there was no significant difference between the two groups (P>0.05). There was a statistically significant difference in the visual analogue scores of pain between the two groups at 1 and 7 days after surgery (P<0.05); the difference was not statistically significant (P>0.05) between preoperative, postoperative and 12 months. There was no significant difference in the scores of the quality of life scale between the two groups before operation, at 1, 2, 6 and 12 months after operation (P>0.05).

Conclusion

TEP procedure for bilateral inguinal hernia effectively reduces operation time, early postoperative pain, and hospital stay.

Key words: Hernia, inguinal, Herniorrhaphy, Laparoscopes, Modified Kugel repair
表1 2组患者基线资料比较
项目 TEP组(71例) 改良Kugel组(86例) P值
年龄(岁, ±s) 52.7±13.6 54.6±14.1 >0.05
性别(男性/女性) 65/6 76/10 >0.05
平均体质量指数(kg/m2, ±s) 24.8±2.4 25.6±2.5 >0.05
身体质量指数>27[例(%)] 21(30) 27(31) >0.05
麻醉风险分级(例)     >0.05
  Ⅰ级 18 14  
  Ⅱ级 47 65  
  Ⅲ级 6 7  
疝分型(例)     >0.05
  Ⅰ级 32 49  
  Ⅱ级 23 22  
  Ⅲ级 16 15  
疝囊平均大小(cm) 2.2 1.9  
疝类型(例)     >0.05
  双侧斜疝 42 51  
  双侧直疝 21 23  
  斜疝/直疝 8 12  
表2 2组患者术后并发症发生情况（例）
组别 例数 切口感染 切口血肿 切口血清肿 尿潴留 睾丸炎
TEP组 71 1 1 2 1 0
改良Kugel组 86 2 2 4 1 1
表3 2组患者VSA评分的比较（分，±s）
组别 例数 术前 术后1 d 术后7 d 术后2个月 术后12个月
TEP组 71 3.01±0.88 2.49±0.71 1.72±0.53 0.69±0.42 0.13±0.33
改良Kugel组 86 3.11±0.75 4.61±0.83 2.98±0.59 0.98±0.38 0.15±0.36
P值   >0.05 <0.05 <0.05 >0.05 >0.05
表4 2组患者术后SF-36量表评分比较（分，±s）
组别 例数 术前 术后1个月 术后2个月 术后6个月 术后12个月
TEP组 71 70.6±4.8 85.9±6.2 90.3±5.5 93.8±4.7 95.4±5.2
改良Kugel组 86 71.3±5.9 83.9±6.8 89.8±6.3 93.2±5.1 95.1±5.5
P值   >0.05 >0.05 >0.05 >0.05 >0.05
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