切换至 "中华医学电子期刊资源库"
高级检索
中华疝和腹壁外科杂志(电子版)

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
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

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/OL]. 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/OL]. 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
[1]
Claus CM, Rocha GM, Campos AC, et al. Prospective, randomized and controlled study of mesh displacement after laparoscopic inguinal repair: fixation versus no fixation of mesh[J]. Surg Endosc, 2016, 30(3): 1134-1140.
[2]
Bay-Nielsen M, Kehlet H, Strand L, et al. Danish Hernia database collaboration. Quality assessment of 26 304 herniorrhaphies in Denmark: a prospective nationwide study[J]. Lancet, 2001, 358(9288): 1124-1128.
[3]
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.
[4]
Chen DC, Amid PK. Prevention of inguinodynia: the need for continuous refinement and quality improvement in inguinal hernia repair[J]. World J Surg, 2014, 38(10): 2571-2573.
[5]
Rosenberg J, Bisgaard T, Kehlet H, et al. Danish Hernia Database recommendations for the management of inguinal and femoral hernia in adults[J]. Dan Med Bull, 2011, 58(2): C 4243.
[6]
Ross SW, Oommen B, Kim M, et al. Tacks, staples, or suture: method of peritoneal closure in laparoscopic transabdominal preperitoneal inguinal hernia repair effects early quality of life[J]. Surg Endosc, 2015, 29(7): 1686-1693.
[7]
Jin J, Rosen MJ. Laparoscopic verus open ventral hernia repair[J]. Surg Clin North Am, 2008, 88(5): 1083-1100.
[8]
Moher D, Hopewell S, Schulz KF, et al. CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trial[J]. Int J Surg, 2012, 10(1): 28-55.
[9]
Subwongcharoen S. Outcome of inguinal hernia repair total extraperitoneal laparoscopic hernia repair versus open tension free repair(Lichtenstein technique)[J]. J Med Assoc Tai, 2002, 85(10): 1100-1104.
[10]
Dhankhar DS, Sharma N, Mishra T, et al. Totally extraperitoneal repair under general anesthesia versus Lichtenstein repair under local anesthesia for unilateral inguinal hernia: a prospective randomized controlled trial[J]. Surg Endosc 2014, 28(3): 996-1002.
[11]
Bobo Z, Nan W, Qin Q, et al. Meta-analysis of randomized controlled trials comparing Lichtenstein and totally extraperitoneal laparoscopic hernioplasty in treatment of inguinal hernias[J]. Journal of surgical research, 2014, 192(2): 409-420.
[12]
Eker HH, Langeveld HR, Klitsie PJ, et al. Randomized clinical trial of total extraperitoneal inguinal hernioplasty vs Lichtenstein repair: a long-term follow-up study[J]. Arch Surg, 2012, 147(3): 256-260.
[13]
Burgmans JP, Voorbrood CE, Simmermacher RK, et al. Long-term results of a randomized double-blinded prospective trial of a lightweight(Ultrapro) versus a heavyweight mesh(Prolene) in laparoscopic total extraperitoneal inguinal hernia repair(TULP-trial) [J]. Ann Surg, 2016, 263(5): 862-866.
[14]
Wennergren JE, Plymale M, Davenport D, et al. Quality-of-life scores in laparoscopic preperitoneal inguinal hernia repair[J]. Surg Endosc, 2016, 30(8): 3467-3473.
[15]
Wijerathne S, Agarwal N, Ramzi A, et al. Single-port versus conventional laparoscopic total extra-peritoneal inguinal hernia repair: a prospective, randomized, controlled clinical trial[J]. Surg Endosc, 2016, 30(4): 1356-1363.
[16]
Ross SW, Oommen B, Kim M, et al. Tacks, staples, or suture: method of peritoneal closure in laparoscopic transabdominal preperitoneal inguinal hernia repair effects early quality of life[J]. Surg Endosc, 2015, 29(7): 1686-1693.
[17]
O'Reilly EA, Burke JP, O'Connell PR. A meta-analysis of surgical morbidity and recurrence after laparoscopic and open repair of primary unilateral inguinal hernia[J]. Ann Surg, 2012, 255(5): 846-853.
[1] 燕速, 霍博文. 腹腔镜食管胃结合部腺癌根治性切除术[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 13-13.
[2] 母德安, 李凯, 张志远, 张伟. 超微创器械辅助单孔腹腔镜下脾部分切除术[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 14-14.
[3] 李国新, 陈新华. 全腹腔镜下全胃切除术食管空肠吻合的临床研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 1-4.
[4] 李子禹, 卢信星, 李双喜, 陕飞. 食管胃结合部腺癌腹腔镜手术重建方式的选择[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 5-8.
[5] 李乐平, 张荣华, 商亮. 腹腔镜食管胃结合部腺癌根治淋巴结清扫策略[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 9-12.
[6] 陈方鹏, 杨大伟, 金从稳. 腹腔镜近端胃癌切除术联合改良食管胃吻合术重建His角对术后反流性食管炎的效果研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 15-18.
[7] 许杰, 李亚俊, 韩军伟. 两种入路下腹腔镜根治性全胃切除术治疗超重胃癌的效果比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 19-22.
[8] 李刘庆, 陈小翔, 吕成余. 全腹腔镜与腹腔镜辅助远端胃癌根治术治疗进展期胃癌的近中期随访比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 23-26.
[9] 任佳, 马胜辉, 王馨, 石秀霞, 蔡淑云. 腹腔镜全胃切除、间置空肠代胃术的临床观察[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 31-34.
[10] 王庆亮, 党兮, 师凯, 刘波. 腹腔镜联合胆道子镜经胆囊管胆总管探查取石术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 313-313.
[11] 杨建辉, 段文斌, 马忠志, 卿宇豪. 腹腔镜下脾部分切除术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 314-314.
[12] 叶劲松, 刘驳强, 柳胜君, 吴浩然. 腹腔镜肝Ⅶ+Ⅷ段背侧段切除[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 315-315.
[13] 郭兵, 王万里, 何凯, 黄汉生. 腹腔镜下肝门部胆管癌根治术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(01): 143-143.
[14] 李凯, 陈淋, 苏怀东, 向涵, 张伟. 超微创器械在改良单孔腹腔镜巨大肝囊肿开窗引流及胆囊切除中的应用[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(01): 144-144.
[15] 魏丽霞, 张安澜, 周宝勇, 李明. 腹腔镜下Ⅲb型肝门部胆管癌根治术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(01): 145-145.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号