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中华疝和腹壁外科杂志(电子版) ›› 2020, Vol. 14 ›› Issue (06) : 629 -632. doi: 10.3877/cma.j.issn.1674-392X.2020.06.011

所属专题: 文献

临床论著

腹腔镜经腹腹膜前疝修补术对患者术后应激反应及疼痛的影响
阮华1,(), 夏青萍1, 李劲平2   
  1. 1. 311106 浙江省,杭州市余杭区中医院普外科
    2. 410000 长沙,中南大学湘雅医院普外科
  • 收稿日期:2019-11-08 出版日期:2020-12-20
  • 通信作者: 阮华
  • 基金资助:
    湖南省自然科学基金立项计划(2017JJ2338)

Effect of laparoscopic transabdominal preperitoneal hernia repair on postoperative stress response and pain

Hua Ruan1,(), Qingping Xia1, Jinping Li2   

  1. 1. Department of General Surgery, Yuhang District Hospital of Traditional Chinese Medicine, Hangzhou 311106, Zhejiang Province, China
    2. Department of General Surgery, Xiangya Hospital, Central South University, Changsha 410000, Hunan Province, China
  • Received:2019-11-08 Published:2020-12-20
  • Corresponding author: Hua Ruan
引用本文:

阮华, 夏青萍, 李劲平. 腹腔镜经腹腹膜前疝修补术对患者术后应激反应及疼痛的影响[J/OL]. 中华疝和腹壁外科杂志(电子版), 2020, 14(06): 629-632.

Hua Ruan, Qingping Xia, Jinping Li. Effect of laparoscopic transabdominal preperitoneal hernia repair on postoperative stress response and pain[J/OL]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2020, 14(06): 629-632.

目的

探讨腹腔镜经腹腹膜前疝修补术(TAPP)对患者术后并发症及疼痛的影响。

方法

收集2018年4~11月收治的128例腹股沟斜疝患者,随机数表法分为TAPP组(64例)和对照组无张力疝修补术(64例)。比较2组临床指标、应激激素水平、疼痛情况和并发症。

结果

TAPP组术后下床时间、术后疼痛持续时间和平均住院时间均低于对照组(P<0.05),2组患者的术后进食时间无明显统计学差异(P>0.05)。与术前比较,术后3 d 2组皮质醇(Cor)和醛固酮(ALD)水平均升高(P<0.05),对照组去甲肾上腺素(NE)水平显著升高(P<0.05)。术后3 d,TAPP组Cor、NE和ALD水平低于对照组,差异具有统计学意义(P<0.05)。与术后24 h比较,术后72 h 2组简式疼痛问卷表(SF-MPQ)评分和视觉模拟评分(VAS)均降低(P<0.05),且TAPP组VAS评分和SF-MPQ评分低于对照组(P<0.05)。

结论

TAPP手术是治疗腹股沟疝的有效手段,与无张力疝修补术相比在减少术后疼痛和并发症方面具有明显优势,术后应激反应较低。

Objective

To explore the effect of laparoscopic transabdominal preperitoneal hernia repair (TAPP) on postoperative complications and pain.

Methods

128 patients with inguinal hernia were divided into the TAPP group (n=64, TAPP) and the control group (n=64, tension-free hernia repair) by Random number table. The clinical indexes, levels of stress hormone, pain and complications were compared between the two groups.

Results

The time of getting out of bed, pain duration and average hospital stay in the TAPP group were lower than those in the control group (P<0.05). There was no statistically significant difference in postoperative feeding time between the two groups (P>0.05). Compared with before operation, the levels of cortisol (Cor) and aldosterone (ALD) in the two groups increased at 3 days after operation (P<0.05), while the levels of norepinephrine (NE) in the control group increased significantly (P<0.05). At 3 days after operation, the levels of Cor, NE and ALD in the TAPP group were lower than those in the control group, with statistical differences (P<0.05). Compared with those at 24 hours after operation, the scores of SF-MPQ and VAS in the two groups decreased at 72 hours after operation (P<0.05), and the scores of SF-MPQ and VAS in the TAPP group were lower than those in the control group (P<0.05).

Conclusion

TAPP is an effective method to treat inguinal hernia. Compared with tension-free hernia repair, TAPP has obvious advantages in reducing postoperative pain and complications, and has lower postoperative stress response.

表1 2组患者术后临床相关指标比较(±s
表2 2组患者术前术后应激激素水平比较(±s
表3 2组患者术后疼痛指标VAS和SF-MPQ比较(分,±s
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