整体式精索游离与分离式精索游离在疝修补术中的对照研究

doi:10.3877/cma.j.issn.1674-392X.2022.02.018

目的

对比开放腹股沟疝修补术中整体式精索游离与分离式游离两种方法的疗效。

方法

回顾分析2020年5月至2021年5月首都医科大学附属北京朝阳医院及陕西省森工医院收治的80例患者的临床资料，按照精索游离方式不同分为2组。观察组42例，采用整体式精索游离；对照组38例，采用分离式游离。全部患者在局部麻醉下行腹膜前无张力疝修补术，收集患者的临床资料，对比2组患者的临床指标。

结果

2组患者均顺利完成手术。观察组患者手术时间与对照组比较，差异无统计学意义（P>0.05）；观察组患者术中出血量少于对照组（P<0.05）；观察组患者术后暂时性神经感觉异常发生率、血清肿等与对照组无明显差异（P>0.05）；术后2组患者均无复发病例。

结论

整体式精索游离与分离式精索游离都是安全、有效的，整体式精索游离基于膜解剖基础，具有损伤小，不破坏精索整体结构，分离式精索游离虽然破坏了提睾肌的整体结构，在严密止血及神经保护后，术中出血及术后出现区域内感觉异常发生率无明显差异，二者均具有借鉴推广价值。

关键词: 疝，腹股沟, 精索, 并发症

Objective

To compare the efficacy of integrated spermatic cord dissociation and separate dissociation in open inguinal hernia repair.

Methods

The clinical data of 80 patients admitted to Beijing Chaoyang Hospital Affiliated to Capital Medical University and Shaanxi Forest Engineering Hospital from May 2020 to May 2021 were retrospectively analyzed. Patients were divided into 2 groups according to different methods of spermatic cord dissociation. The observation group 42 cases using integrated spermatic cord dissociation, the control group 38 cases using separate dissociation. All patients underwent preperitoneal tension-free hernia repair under local anesthesia. The clinical data of patients were collected. The clinical indicators of the two groups were compared.

Results

All patients in 2 groups successfully completed surgery. The operation time between observation group and the control group had no significant difference (P>0.05). The intraoperative blood loss of the observation group was less than the control group (P<0.05). The postoperative incidence of temporary nerve paresthesia and seroma between the observation group and the control group had no significant difference (P>0.05). There was no recurrence in 2 groups of patients after operation.

Conclusion

Integrated and separate spermatic cord dissociation were both safe and effective. Integrated spermatic cord dissociation was based on anatomical basis, with a small injury, without destroying the spermatic integral structure. Although separate spermatic cord dissociation destroyed the whole structure of the testosterone muscle, the rates of intraoperative bleeding and postoperative incidence of abnormal area feel had no significant difference after hemostasis and nerve protection. Both spermatic cord dissociation methods have reference and promotion value.

Key words: Hernia, inguinal, Spermatic cord, Complications

表1 2组患者一般资料比较

组别	例数	年龄(年,±s)	体质量指数(kg/m²,±s)	左侧疝/右侧疝[例(%)]	斜疝/直疝[例(%)]
观察组	42	55.34±13.89	19.55±2.39	17(40.48)/25(59.52)	31(73.81)/11(26.18)
对照组	38	56.96±14.01	19.70±2.51	15(39.47)/23(60.53)	29(76.32)/9(23.68)
t/χ²值		3.134	2.009	6.348	5.234
P值		0.187	0.236	0.110	0.281

表1 2组患者一般资料比较

组别	例数	年龄(年,±s)	体质量指数(kg/m²,±s)	左侧疝/右侧疝[例(%)]	斜疝/直疝[例(%)]
观察组	42	55.34±13.89	19.55±2.39	17(40.48)/25(59.52)	31(73.81)/11(26.18)
对照组	38	56.96±14.01	19.70±2.51	15(39.47)/23(60.53)	29(76.32)/9(23.68)
t/χ²值		3.134	2.009	6.348	5.234
P值		0.187	0.236	0.110	0.281

表2 2组患者临床指标比较

组别	例数	手术时间(min, ±s)	术中出血量(ml, ±s)	术后疼痛评分(分, ±s)	术后感觉异常[例(%)]
观察组	42	50.67±6.26	6.16±4.06	3.23±0.77	1(2.38)
对照组	38	54.58±6.18	10.44±5.16	3.19±0.75	1(2.63)
t/χ²值		2.225	1.178	5.339	4.378
P值		0.205	0.540	0.321	0.191

表2 2组患者临床指标比较

组别	例数	手术时间(min, ±s)	术中出血量(ml, ±s)	术后疼痛评分(分, ±s)	术后感觉异常[例(%)]
观察组	42	50.67±6.26	6.16±4.06	3.23±0.77	1(2.38)
对照组	38	54.58±6.18	10.44±5.16	3.19±0.75	1(2.63)
t/χ²值		2.225	1.178	5.339	4.378
P值		0.205	0.540	0.321	0.191

表3 2组患者术后并发症情况比较[例（%）]

组别	例数	血清肿	复发	缺血性睾丸炎	感染
观察组	42	5(11.90)	0(0)	0(0)	0(0)
对照组	38	4(10.53)	0(0)	0(0)	0(0)
χ²值		2.225	1.178	5.339	4.378
P值		0.205	0.540	0.321	0.191

表3 2组患者术后并发症情况比较[例（%）]

组别	例数	血清肿	复发	缺血性睾丸炎	感染
观察组	42	5(11.90)	0(0)	0(0)	0(0)
对照组	38	4(10.53)	0(0)	0(0)	0(0)
χ²值		2.225	1.178	5.339	4.378
P值		0.205	0.540	0.321	0.191

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Comparative study of integrated and separate spermatic cord dissociation in hernia repair

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Comparative study of integrated and separate spermatic cord dissociation in hernia repair