腹腔镜经腹腹膜前疝修补术和开放疝修补术治疗嵌顿性腹股沟疝的对比研究

doi:10.3877/cma.j.issn.1674-392X.2021.06.012

目的

比较腹腔镜经腹腹膜前疝修补术（TAPP）和开放无张力疝修补术治疗嵌顿性腹股沟疝的临床疗效。

方法

回顾性分析2018年11月至2020年11月于庐江县人民医院诊治的60例嵌顿性腹股沟疝患者作为研究对象。根据行不同的手术类型，分别入组为试验组和对照组，各30例。试验组行TAPP，对照组行开放无张力疝修补术。比较2组手术临床指标、术后疼痛情况，并统计2组术后并发症发生率及复发率。

结果

试验组的围手术期临床指标如手术时间长于对照组，而排气时间、术后下床活动时间及住院时间均较对照组更短（P<0.05），2组患者在术后6个月的阶段内视觉模拟评估法（VAS）评分均有明显降低（P<0.05），而试验组术后3、6个月的VAS评分较对照组的降低情况更佳（P<0.05）。随访2~12个月，试验组与对照组并发症总发生情况分别为3例（10.0%）和4例（13.3%），差异无统计学意义（P>0.05）。

结论

TAPP手术较开放无张力疝修补术治疗嵌顿性腹股沟疝具有术后恢复快、疼痛小等优势，且并未增加患者的并发症发生率。

关键词: 嵌顿性腹股沟疝, 腹腔镜, 疝修补术, 疗效

Objective

To compare the clinical efficacy of laparoscopic trans-abdominal preperitoneal hernia repair (TAPP) and opentension-free hernia repair in the treatment of incarcerated inguinal hernia.

Methods

The clinical data of 60 patients with incarcerated inguinal hernia admitted to our hospital from November 2018 to November 2020 were analyzed, and they were divided into the experiment group (n=30) and the control group (n=30) according to the different operation method. The experiment group underwent TAPP operation, and the control group underwent open tension-free hernia repair. The clinical indicators and postoperative pain of the two groups were compared, and the postoperative complications occurrence rate and recurrence rate of the two groups were counted after operation.

Results

The operation time of the experimental group was significantly longer than that of the control group, while the exhaust time, postoperative time to get out of bed and hospital stay were significantly shorter than those of the control group (P<0.05). The visual analogue scale (VAS) scores of the two groups of patients were significantly reduced from preoperative to 6 months after surgery (P<0.05), and the VAS scores of the experimental group were significantly lower than those of the control group at 3 and 6 months after surgery (P<0.05). Follow-up for 2 to12 months, the total incidence of complications in the experimental group and the control group was 3 cases (10.0%) and 4 cases (13.3%) respectively, and the difference was not statistically significant (P>0.05).

Conclusion

Compared with open tension-free herniorrhaphy in the treatment of incarcerated inguinal hernia, TAPP has the advantages of rapid postoperative recovery and less pain, and does not increase the incidence of complications in patients.

Key words: Incarcerated inguinal hernia, Laparoscopes, Herniorrhaphy, Clinical efficacy

表1 2组围手术期临床指标比较（±s）

组别	例数	手术时间(min)	排气时间(h)	术后下床活动时间(h)	住院时间(d)
试验组	30	87.49±9.78	9.61±1.84	8.15±1.91	3.03±1.25
对照组	30	70.67±7.91	12.92±2.75	10.79±2.38	6.37±1.48
t值		16.347	5.603	4.832	3.839
P值		<0.05	<0.05	<0.05	<0.05

表1 2组围手术期临床指标比较（±s）

组别	例数	手术时间(min)	排气时间(h)	术后下床活动时间(h)	住院时间(d)
试验组	30	87.49±9.78	9.61±1.84	8.15±1.91	3.03±1.25
对照组	30	70.67±7.91	12.92±2.75	10.79±2.38	6.37±1.48
t值		16.347	5.603	4.832	3.839
P值		<0.05	<0.05	<0.05	<0.05

表2 2组手术前后疼痛视觉模拟评分比较（分，±s）

组别	例数	术前	术后1周	术后3个月	术后6个月	F值	P值
试验组	30	4.52±1.01	1.79±0.70	1.13±0.35	0.63±0.21	215.353	<0.05
对照组	30	4.57±1.03	2.13±0.81	1.42±0.47	0.97±0.30	143.081	<0.05
t值		0.193	1.763	2.741	5.138	-	-
P值		>0.05	>0.05	<0.05	<0.05	-	-

表2 2组手术前后疼痛视觉模拟评分比较（分，±s）

组别	例数	术前	术后1周	术后3个月	术后6个月	F值	P值
试验组	30	4.52±1.01	1.79±0.70	1.13±0.35	0.63±0.21	215.353	<0.05
对照组	30	4.57±1.03	2.13±0.81	1.42±0.47	0.97±0.30	143.081	<0.05
t值		0.193	1.763	2.741	5.138	-	-
P值		>0.05	>0.05	<0.05	<0.05	-	-

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Comparative study of laparoscopic trans-abdominal preperitoneal hernia repair and open tension-free herniorrhaphy for incarcerated inguinal hernia

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Comparative study of laparoscopic trans-abdominal preperitoneal hernia repair and open tension-free herniorrhaphy for incarcerated inguinal hernia