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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) ›› 2021, Vol. 15 ›› Issue (03) : 300 -303. doi: 10.3877/cma.j.issn.1674-392X.2021.03.022

临床论著

腹腔镜经腹腹膜前疝修补术中不同疝囊处理方式的对比研究
黄文海1, 姜笑明1,†()   
  1. 1. 复旦大学附属金山医院普外科
  • 收稿日期:2020-03-05 出版日期:2021-06-18
  • 通信作者: 姜笑明

A controlled study of different hernia sac management in laparoscopic transabdominal preperitoneal procedure for indirect inguinal hernia

Wenhai Huang1, Xiaoming Jiang1,†()   

  1. 1. Department of General Surgery, Jinshan Hospital of Fudan University, Shanghai 201508, China
  • Received:2020-03-05 Published:2021-06-18
  • Corresponding author: Xiaoming Jiang
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黄文海, 姜笑明. 腹腔镜经腹腹膜前疝修补术中不同疝囊处理方式的对比研究[J]. 中华疝和腹壁外科杂志(电子版), 2021, 15(03): 300-303.

Wenhai Huang, Xiaoming Jiang. A controlled study of different hernia sac management in laparoscopic transabdominal preperitoneal procedure for indirect inguinal hernia[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2021, 15(03): 300-303.

目的

对比分析腹腔镜经腹腹膜前疝修补术（TAPP）在治疗腹股沟斜疝中不同疝囊处理方式对手术并发症的影响。

方法

收集2017年1月至2019年1月复旦大学附属金山医院收治的原发性腹股沟斜疝患者80例，分为试验组和对照组，每组患者40例。试验组术中横断斜疝疝囊，对照组术中完全还纳疝囊。对比2组疝囊处理时间、手术时间、术后血肿发生率、血清肿发生率、急性疼痛发生率、慢性疼痛发生率、住院时间、复发率和其他并发症情况。

结果

疝囊处理时间方面，试验组明显短于对照组[（9.2±3.42）min比（26.7±8.93 min），P<0.01]；2组的手术时间分别为（42.2±4.33）min和（59.0±8.44）min，差异有统计学意义（P<0.01）。2组患者的术后住院时间无显著差异。2组患者的血肿发生率、血清肿发生率、急性疼痛发生率、慢性疼痛发生率和复发率方面没有统计学差异。

结论

TAPP治疗腹股沟斜疝时疝囊横断减少了操作时间，不增加血清肿、急性或慢性疼痛等并发症发生率。

关键词: 腹股沟斜疝, 腹腔镜, 疝囊, 血清肿, 疼痛, 复发
Objective

To compare the effects of different treatment methods of hernia sac on surgical complications of laparoscopic transabdominal preperitoneal (TAPP) repair in the treatment of indirect inguinal hernia.

Methods

A total of 80 patients with primary indirect inguinal hernia admitted to Jinshan Hospital of Fudan University from January 2017 to January 2019 were collected and divided into experimental group and control group, with 40 cases in each group. Intraoperative transection of the indirect hernia sac was performed in the experimental group, and complete restoration of the hernia sac was performed in the control group. The treatment time of hernia sac, operative time, incidence of postoperative hematoma, seroma, acute pain, chronic pain, length of hospital stay, recurrence rate and other complications were compared between the two groups.

Results

The treatment time of hernia sac in the experimental group was significantly shorter than that in the control group [(9.2±3.42) minutes vs (26.7±8.93) minutes, P<0.01]. The operative time of the two groups was (42.2±4.33) minutes and (59.0±8.44) minutes, respectively (P<0.01). There was no significant difference in length of postoperative hospital stay between the two groups. In terms of follow-up, there were no statistically significant differences in the incidence of hematoma, seroma, acute pain, chronic pain, and recurrence between the two groups.

Conclusion

Transection of hernia sac in laparoscopic transabdominal preperitoneal procedure for indirect inguinal hernia reduces the operation time and does not increase the incidence of complications such as seroma, acute or chronic pain.

Key words: Hernia,inguinal, Laparoscope, Hernia sac, Seroma, Pain, Recurrence
表1 2组患者的一般资料比较
变量 试验组(40例) 对照组(40例) P值
性别     0.164
  男性 37(92.50) 38(95.00)
  女性 3(7.50) 2(5.00)
年龄 59.32±8.77 60.14±8.43 0.272
BMI(kg/m2) 18.9±3.1 19.1±3.0 0.209
疝位置     0.339
  左侧 12(30.00) 13(32.50)
  右侧 21(52.50) 22(55.00)
  双侧 7(17.50) 5(12.50)
疝缺损大小(cm)     0.129
  >3 12(30.00) 14(35.00)
  <3 28(70.00) 26(65.00)
ASA分级     0.063
  Ⅰ级 24(60.00) 22(55.00)
  Ⅱ级 16(40.00) 18(45.00)
随访时间(个月) 12.2±0.5 12.4±0.2 0.345
图1 入选病例资料及结果
表2 2组患者临床资料比较
变量 试验组(40例) 对照组(40例) P值
疝囊处理时间(min, ±s) 9.2±3.42 26.7±8.93 0.001
手术时间(min, ±s) 42.2±4.33 59.0±8.44 0.001
住院时间(d, ±s) 2.5±1.15 2.8±1.29 0.156
急性疼痛[例(%)] 2(2.22) 3(3.33) 0.121
血肿[例(%)] 1(1.11) 1(1.11) 0.899
血清肿[例(%)]      
  1周 6(15.00) 7(17.50) 0.066
  1个月 3(7.50) 4(10.00) 0.104
  3个月 1(2.50) 2(5.00) 0.070
慢性疼痛[例(%)] 1(1.11) 2(2.22) 0.299
复发[例(%)] 0 0 -
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