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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) ›› 2022, Vol. 16 ›› Issue (05) : 552 -556. doi: 10.3877/cma.j.issn.1674-392X.2022.05.014

临床论著

腹腔镜经腹腹膜前疝修补术与开放式腹膜前疝修补术治疗股疝的疗效比较
周成明1, 陈少科1, 王风清1, 吴雪影1, 曹峻1,†()   
  1. 1. 830054　乌鲁木齐，新疆医科大学第一附属医院肝脏·腹腔镜外科
  • 收稿日期:2022-04-19 出版日期:2022-10-18
  • 通信作者: 曹峻

Comparison of surgical outcomes and quality of life of TAPP versus open preperitoneal hernia repair for the treatment of femoral hernia

Chengming Zhou1, Shaoke Chen1, Fengqing Wang1, Xueying Wu1, Jun Cao1,†()   

  1. 1. Department of Liver and Laparoscopic Surgery, the First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
  • Received:2022-04-19 Published:2022-10-18
  • Corresponding author: Jun Cao
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周成明, 陈少科, 王风清, 吴雪影, 曹峻. 腹腔镜经腹腹膜前疝修补术与开放式腹膜前疝修补术治疗股疝的疗效比较[J]. 中华疝和腹壁外科杂志(电子版), 2022, 16(05): 552-556.

Chengming Zhou, Shaoke Chen, Fengqing Wang, Xueying Wu, Jun Cao. Comparison of surgical outcomes and quality of life of TAPP versus open preperitoneal hernia repair for the treatment of femoral hernia[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2022, 16(05): 552-556.

目的

比较腹腔镜经腹腹膜前疝修补术（TAPP）与开放式腹膜前疝修补术治疗股疝的手术结果和对生活质量的影响。

方法

回顾性分析2014年1月至2019年12月新疆医科大学第一附属医院收治的58例股疝患者的临床资料，根据手术方式不同分为TAPP组和开放式腹膜前疝修补术组（开放组），TAPP组31例，开放组27例。比较两组手术指标，采用卡罗来纳舒适量表（CCS）评估并比较两组患者术前及术后1、6、12和24个月的生活质量。

结果

TAPP组在手术时间、术中出血量、术后住院天数及术后并发症发生率等方面和开放组相比差异无统计学意义（P>0.05）；TAPP组在术后24 h疼痛视觉模拟评分及术后镇痛药使用率方面明显优于开放组（P<0.05）；TAPP组术后离床时间及术后首次进食时间长于开放组（P<0.05）；2组患者术后随访24个月，均无复发病例。两种术式均能有效改善患者术前的疼痛、运动受限及总体生活质量（P<0.05）；TAPP组患者术后1个月疼痛及总体生活质量优于开放组（P<0.05）。

结论

TAPP与开放式腹膜前疝修补术均可有效治疗股疝。TAPP可作为无全身麻醉禁忌股疝患者的首选治疗方法。股疝的治疗应依据患者的自身情况和手术医师的技术掌握程度制定个体化治疗方案。

关键词: 股疝, 腹腔镜, 疝修补术, 生活质量
Objective

To compare the surgical outcomes and quality of life between TAPP and open preperitoneal repair for the treatment of femoral hernia.

Methods

From January 2014 to December 2019, the clinical data of 58 patients with femoral hernia treated at Xinjiang Medical University's First Affiliated Hospital were retrospectively analyzed. Patients were divided into the TAPP group (n=31) and the open group (n=27) according to different surgical methods. The surgical outcomes were recorded and compared between the two groups. In addition, the quality of life of the two groups was evaluated and compared before surgery and 1, 6, 12 and 24 months after surgery using the Carolinas Comfort Scale (CCS).

Results

There was no significant difference in terms of operation time, intraoperative blood loss, postoperative hospital stay and incidence of postoperative complications between the TAPP group and the open group (P>0.05). The VAS score at 24 h after surgery and the utilization rate of postoperative analgesics in the TAPP group were significantly lower than those in the open group (P<0.05). The postoperative ambulation time and the first postoperative feeding time in the TAPP group were significantly longer than those in the open group (P<0.05). After 24 months of follow-up, there were no recurrences in the TAPP group or the open group. Both TAPP and open preperitoneal repair could effectively improve the preoperative pain, movement limitation and overall quality of life of patients (P<0.05). The pain and overall quality of life in TAPP group were better than those in open group one month after surgery (P<0.05).

Conclusion

TAPP and open preperitoneal hernia repair can effectively treat femoral hernia. TAPP can be used as the preferred treatment for patients with femoral hernia without general anesthesia contraindication.The appropriate surgical method for femoral hernia should be individualized according to the patient's own situation and the surgical skill level of the surgeon.

Key words: Hernia, femoral, Laparoscopic, Herniorrhaphy, Quality of life
表1 2组患者术前一般资料比较[例（%）]
组别 例数 性别(男/女) 年龄(岁,±s) 侧别(左/右) 便秘 前列腺增生 COPD 长期负重史 难复性疝 CCS评分≥2分
疼痛 运动受限 总体生活质量
TAPP组 31 9(29.0)/22(71.0) 58.26±16.09 10(32.3)/21(67.7) 2(6.45) 3(9.68) 1(3.23) 5(16.13) 1(3.23) 13(41.94) 9(29.03) 14(45.16)
开放组 27 6(22.2)/21(77.8) 57.59±12.32 8(29.6)/19(70.4) 3(11.11) 2(7.41) 3(11.11) 7(25.93) 2(7.41) 14(51.85) 11(40.74) 19(70.37)
t/χ2   0.35 0.18 0.05 0.39 0.09 1.39 0.84 0.51 0.57 0.88 3.74
P值   0.555 0.86 0.829 0.656 1.000 0.329 0.358 0.593 0.450 0.349 0.053
表2 2组患者手术指标比较（±s）
组别 例数 手术时间(min) 术中出血量(ml) 术后离床时间(h) 术后首次进食时间(h) 术后24 h VAS评分(分) 术后住院天数(d) 术后镇痛药使用[例(%)] 术后并发症[例(%)] 复发[例(%)]
TAPP组 31 55.71±6.89 2.68±0.93 6.26±0.81 9.06±0.73 2.16±0.73 2.45±0.93 2(6.45) 2(6.45) 0
开放组 27 55.59±6.31 2.82±0.92 3.07±1.41 2.63±1.59 2.59±0.57 2.63±0.97 8(29.63) 2(7.41) 0
t/χ2   0.07 0.57 10.73 20.13 2.47 0.72 5.43 0.02  
P值   0.104 0.592 0.000 0.000 0.017 0.477 0.034 1.000  
图1 股疝修补术生活质量指标-疼痛的结果注：纵轴为CCS评分≥2分患者百分比；两种术式均能改善术前的疼痛（P<0.05）；TAPP组在术后1个月疼痛轻于开放组（P<0.05）；两种术式在术后6、12及24个月疼痛差异无统计学意义（P>0.05）
图2 股疝修补术生活质量指标-运动受限的结果注：纵轴为CCS评分≥2分患者百分比；两种术式均能改善术前的运动受限（P<0.05）；两种术式在术后1、6、12及24个月运动受限比较差异无统计学意义（P>0.05）
图3 股疝修补术生活质量指标-补片异物感的结果注：纵轴为CCS评分≥2分患者百分比；两种术式在术后1、6、12及24个月补片异物感比较差异无统计学意义（P>0.05）
图4 股疝修补术总体生活质量结果注：纵轴为CCS评分≥2分患者百分比；两种术式均能改善术前的总体生活质量（P<0.05）；TAPP组在术后1个月总体生活质量优于开放组，P<0.05；两种术式在术后6、12及24个月总体生活质量差异无统计学意义（P>0.05）
[1]
Wang D, Shen Y, Wang F, et al. Mini-mesh and Lichtenstein repair compared with a modified Kugel technique for femoral hernia: a randomised controlled trial[J]. Ann R Coll Surg Engl, 2020, 102(4): 284-289.
[2]
王志涛，关磊，聂玉胜, 等. 腹腔镜经腹膜前与局麻下开放式腹膜前疝修补术治疗股疝的对比研究[J/OL]. 中华疝和腹壁外科杂志(电子版), 2020, 14(4): 366-369.
[3]
Clyde D R, de Beaux A, Tulloh B, et al. Minimising recurrence after primary femoral hernia repair; is mesh mandatory？[J]. Hernia, 2020, 24(1): 137-142.
[4]
Lockhart K, Dunn D, Teo S, et al. Mesh versus non-mesh for inguinal and femoral hernia repair[J]. Cochrane Database Syst Rev, 2018, 9(9): CD011517.
[5]
侯海生，杨利，闫小伟. 腹腔镜腹股沟疝修补应用轻质3D Max补片与普通补片的效果比较[J]. 中国组织工程研究, 2020, 24(28): 4588-4592.
[6]
Xie Y, Song Y, Ma D, et al. A prospective study on femoral hernia repair: is the inguinal better than the infrainguinal approach?[J]. J Surg Res, 2019, 233: 420-425.
[7]
Liu X, Ye L, Zheng G, et al. A retrospective cohort study of open preperitoneal repair versus open suture repair for the treatment of emergency femoral hernia[J]. Sci Rep, 2020, 10(1): 3707.
[8]
范国勇，姚干. 腹腔镜下腔隙韧带切开治疗嵌顿股疝的临床分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2021, 15(1): 22-26.
[9]
Cox T C, Huntington C R, Blair L J, et al. Quality of life and outcomes for femoral hernia repair: does laparoscopy have an advantage?[J]. Hernia, 2017, 21(1): 79-88.
[10]
Chen D, Su N, Wang W, et al. Laparoscopic transabdominal preperitoneal technique versus open surgery with the ULTRAPRO Hernia System for the repair of female primary femoral hernias—an observational retrospective study[J]. Medicine(Baltimore), 2018, 97(49): e13575.
[11]
Kafadar M T, Gök M A. Laparoscopic transabdominal preperitoneal repair of strangulated femoral hernia: Superiority of an unusual emergency surgical approach due to a case[J]. Ann Med Surg(Lond), 2018, 36: 110-112.
[12]
李赞林，塞米·赛买提，李义亮, 等. 股疝修补术的临床疗效分析[J]. 中华消化外科杂志, 2020, 19(7): 762-766.
[13]
张进，王峰，赵文波, 等．腹腔镜与开放行经腹膜前间隙股疝修补术的对比研究[J]. 中国药物与临床, 2019, 19(4): 594-596.
[14]
苏宝威，李旭慧，白明辉, 等．腹腔镜经腹膜前疝修补术治疗老年人股疝[J]. 中国老年保健医学, 2019, 17(6): 112-114.
[15]
Kunduz E, Sormaz İC, Yapalak Y, et al. Comparison of surgical techniques and results for emergency or elective femoral hernia repair[J]. Ulus Travma Acil Cerrahi Derg, 2019, 25(6): 611-615.
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