聚丙烯和聚乳酸复合补片对腹腔镜疝修补术患者疗效及应激状态的影响

doi:10.3877/cma.j.issn.1674-392X.2022.05.018

目的

观察聚丙烯和聚乳酸复合补片对腹腔镜疝修补术患者应激状态的影响及其治疗效果。

方法

选择张家港市中医医院2018年12月至2021年6月以来的152例拟行腹腔镜手术治疗的腹股沟疝患者作为研究对象，随机分为对照组（76例）和观察组（76例）。对照组采用聚丙烯补片，观察组采用聚丙烯和聚乳酸复合补片。比较2组手术时间、术中并发症发生情况、术后住院时间、术后下床时间、住院费用、术后疼痛情况、血清炎性因子白细胞介素-6（IL-6）、C反应蛋白（CRP）水平及并发症情况。

结果

观察组手术时间、住院花费高于对照组（P<0.05）；术后1 d、10 d、1个月、3个月，2组患者VAS评分均逐渐下降，且观察组VAS评分低于对照组（P<0.05）。术后与术前相比，2组血清IL-6、CRP水平显著升高（P<0.05），且观察组指标均优于对照组（P<0.05）。观察组患者并发症总发生率3.95%（3/76），低于对照组的9.21%（7/76），但2组比较差异无统计学意义（P>0.05）。随访1年，观察组复发率为0（0/76），对照组复发率为1.32%（1/76），二者比较差异无统计学意义（P>0.05）。

结论

采用自固定聚丙烯和聚乳酸复合补片能够减少患者术后应激反应，不增加并发症，利于患者术后恢复。

关键词: 疝，腹股沟, 疝修补术, 腹腔镜, 补片, 疗效, 应激反应

Objective

To compare the effects of polypropylene and polylactic acid composite mesh on the stress state of patients undergoing laparoscopic hernia repair and its therapeutic effect.

Methods

A total of 152 patients with inguinal hernia undergoing laparoscopic surgery in our hospital from December 2018 to June 2021 were selected as the research objects and randomly divided into control group (76 cases) and observation group (76 cases). The control group was treated with polypropylene mesh, and the observation group was treated with polypropylene and polylactic acid mesh. Operation time, intraoperative complications, postoperative hospital stay, postoperative time to get out of bed, hospitalization costs, postoperative pain, serum interleukin-6 (IL-6), C-reactive protein (CRP) levels and complications were compared between the two groups.

Results

The operation time and hospitalization cost in the observation group were higher than those in the control group (P<0.05). At 1 d, 10 d, 1 month, and 3 months after surgery, VAS scores in both groups decreased gradually, and VAS scores in the observation group were lower than those in the control group (P<0.05). The serum IL-6 and CRP levels in both groups were significantly increased after operation compared with before operation (P<0.05), and the indexes in observation group were better than those in the control group (P<0.05). The total incidence of complications in the observation group was 3.59% (3/76), lower than the 9.21% (7/76) in the control group, but there was no statistical significance between the two groups (P>0.05). The recurrence rate was 0.00% (0/76) in the observation group and 1.32% (1/76) in the control group, and there was no significant difference between the two groups (P>0.05).

Conclusion

The use of self-immobilized polypropylene and polylactic acid composite mesh can reduce the postoperative stress reaction of patients, which does not increase and occur complications, which is conducive to postoperative recovery of patients, and can be popularized in clinical application.

Key words: Hernia, inguinal, Herniorrhaphy, Laparoscope, Mesh, Efficacy, Stress reaction

表1 2组术后指标比较（±s）

组别	例数	住院时间(d)	下床时间(h)	住院费用(元)
观察组	76	3.16±0.68	7.95±4.40	12 360.13±1223.90
对照组	76	3.39±0.55	8.03±2.34	6982.95±894.92
t		-2.187	-1.007	5.101
P		0.319	0.210	0.001

表1 2组术后指标比较（±s）

组别	例数	住院时间(d)	下床时间(h)	住院费用(元)
观察组	76	3.16±0.68	7.95±4.40	12 360.13±1223.90
对照组	76	3.39±0.55	8.03±2.34	6982.95±894.92
t		-2.187	-1.007	5.101
P		0.319	0.210	0.001

表2 2组术后疼痛情况比较（分，±s）

组别	例数	1 d	10 d	1个月	3个月
观察组	76	2.00±0.87	1.68±0.62	0.74±0.45	0.21±0.41
对照组	76	3.26±1.06	2.53±0.76	1.79±0.62	0.71±0.46
t		-2.774	-3.107	-2.760	-3.754
P		0.002	0.001	0.001	0.001

表2 2组术后疼痛情况比较（分，±s）

组别	例数	1 d	10 d	1个月	3个月
观察组	76	2.00±0.87	1.68±0.62	0.74±0.45	0.21±0.41
对照组	76	3.26±1.06	2.53±0.76	1.79±0.62	0.71±0.46
t		-2.774	-3.107	-2.760	-3.754
P		0.002	0.001	0.001	0.001

表3 2组炎性因子水平比较（±s）

组别	例数		白细胞介素6 (ng/L)	C反应蛋白(mg/L)
观察组	76	术前	7.93±1.98	2.28±0.41
		术后	11.75±3.14^*#	5.39±0.85^*#
对照组	76	术前	7.66±1.97	2.33±0.21
		术后	16.68±3.65^*	11.18±0.85^*

表3 2组炎性因子水平比较（±s）

组别	例数		白细胞介素6 (ng/L)	C反应蛋白(mg/L)
观察组	76	术前	7.93±1.98	2.28±0.41
		术后	11.75±3.14^*#	5.39±0.85^*#
对照组	76	术前	7.66±1.97	2.33±0.21
		术后	16.68±3.65^*	11.18±0.85^*

表4 2组术后并发症比较[例（%）]

组别	例数	阴囊血清肿	慢性疼痛	异物感	总发生率
观察组	76	3(3.95)	0	0	3(3.95)
对照组	76	4(5.26)	2(2.63)	1(1.32)	7(9.21)
χ²					12.774
P					0.101

表4 2组术后并发症比较[例（%）]

组别	例数	阴囊血清肿	慢性疼痛	异物感	总发生率
观察组	76	3(3.95)	0	0	3(3.95)
对照组	76	4(5.26)	2(2.63)	1(1.32)	7(9.21)
χ²					12.774
P					0.101

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Effect of polypropylene and polylactic acid composite mesh on the therapeutic effect and stress state of patients undergoing laparoscopic hernia repair

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Effect of polypropylene and polylactic acid composite mesh on the therapeutic effect and stress state of patients undergoing laparoscopic hernia repair