轻量聚丙烯补片与自固定补片在Lichtenstein疝修补术的研究

doi:10.3877/cma.j.issn.1674-392X.2023.01.008

目的

对比研究轻量大网孔聚丙烯补片与自固定补片在Lichtenstein疝修补术中的应用。

方法

选择2021年1-3月在吉林大学第二医院60例单侧男性腹股沟疝患者行前瞻性随机对照研究，随机分为轻量大网孔聚丙烯补片组和自固定补片组各30例，分别应用轻量大网孔聚丙烯补片和自固定补片进行Lichtenstein疝修补术；对比2组一般资料、手术相关指标、术后平均住院时间、血清肿、补片感染、术后疼痛、复发、异物感以及治疗费用等相关情况进而评价两种补片的治疗效果。

结果

2组患者一般资料、手术麻醉方式、术后住院时间比较差异无统计学意义（P>0.05），2组的平均手术时间和治疗费用差异有统计学意义（P<0.05）；术后血清肿、术后短期（7 d及1个月）疼痛和慢性疼痛、补片感染、局部不适或异物感、复发等并发症差异均无统计学意义。

结论

自固定补片可明显缩短手术时间，但医疗费用明显高于轻量大网孔聚丙烯补片，在术后复发和慢性疼痛等并发症方面差异不显著。

关键词: 疝，腹股沟, 疝修补术, 补片, 自固定补片, 聚丙烯

Objective

To compare the application effect of lightweight large-pore polypropylene mesh and self-adhesive mesh in Lichtenstein hernia repair.

Methods

A total of 60 unilateral male inguinal hernia patients in the Second Hospital of Jilin University from January to March 2021 were selected for a prospective randomized controlled study. They were randomized into the lightweight large-pore polypropylene mesh group (n=30) and the self-adhesive mesh group (n=30). A tension-free repair using the Lichtenstein technique was performed on all patients. The general data, operation related indicators, postoperative average hospital stays, seroma, mesh infection, postoperative pain, recurrence, foreign body sensation and hospital cost were compared between the two groups, to evaluate the effect of the two types of mesh.

Results

There were no significant differences in general data, anesthesia method and postoperative hospital stay between the two groups (P>0.05). There were significant differences in average operating time and hospital cost between the two groups (P<0.05). There were no significant differences in seroma, short-term postoperative pain (7 day and 1 month) and chronic pain, mesh infection, local discomfort or foreign body sensation, recurrence and other complications.

Conclusions

The self-adhesive mesh can significantly shorten the operation time, but the medical cost is significantly higher than that of the lightweight large-pore polypropylene mesh. And there was no significant difference in postoperative recurrence, chronic pain and other complications.

Key words: Hernia, inguinal, Herniorrhaphy, Mesh, Self-adhesive mesh, Polypropylene

表1 2组患者一般资料比较[例（%）]

组别	例数	年龄(岁,±s)	体质量指数(kg/m²,±s)	确诊至手术时间(月,±s)	疝类型			缺损直径			合并内科疾病
组别	例数	年龄(岁,±s)	体质量指数(kg/m²,±s)	确诊至手术时间(月,±s)	直疝	斜疝	马鞍疝	<1.5 cm	1.5~3 cm	>3 cm	合并内科疾病
A组	30	55.7±6.7	23.9±1.5	26.3±9.8	2( 6.67)	27(90.00)	1(3.33)	10(33.33)	17(56.67)	3(10.00)	6(20.00)
B组	30	57.3±7.5	24.1±1.4	23.0±8.5	3(10.00)	25(83.33)	2(6.67)	8(26.67)	18(60.00)	4(13.33)	5(16.67)
t/χ²		0.87	0.53	-1.39	-			-			-
P值		0.3871	0.5955	0.1688	0.1211^*			0.0588^*			0.2469^*

表1 2组患者一般资料比较[例（%）]

组别	例数	年龄(岁,±s)	体质量指数(kg/m²,±s)	确诊至手术时间(月,±s)	疝类型			缺损直径			合并内科疾病
组别	例数	年龄(岁,±s)	体质量指数(kg/m²,±s)	确诊至手术时间(月,±s)	直疝	斜疝	马鞍疝	<1.5 cm	1.5~3 cm	>3 cm	合并内科疾病
A组	30	55.7±6.7	23.9±1.5	26.3±9.8	2( 6.67)	27(90.00)	1(3.33)	10(33.33)	17(56.67)	3(10.00)	6(20.00)
B组	30	57.3±7.5	24.1±1.4	23.0±8.5	3(10.00)	25(83.33)	2(6.67)	8(26.67)	18(60.00)	4(13.33)	5(16.67)
t/χ²		0.87	0.53	-1.39	-			-			-
P值		0.3871	0.5955	0.1688	0.1211^*			0.0588^*			0.2469^*

表2 2组患者手术相关指标比较（±s）

组别	例数	麻醉方法[例(%)]			平均手术时间(min)	治疗费用(元)	术后住院时间(d)
组别	例数	硬膜外麻醉	全身麻醉	局部麻醉	平均手术时间(min)	治疗费用(元)	术后住院时间(d)
A组	30	24(80.00)	3(10.00)	3(10.00)	40±9	7547±133	2.17±0.42
B组	30	21(70.00)	5(16.67)	4(13.33)	33±7	9322±155	2.01±0.35
t/χ²		-			-3.36	47.60	-1.60
P值		0.0625^*			0.0014	<0.0001	0.1144

表2 2组患者手术相关指标比较（±s）

组别	例数	麻醉方法[例(%)]			平均手术时间(min)	治疗费用(元)	术后住院时间(d)
组别	例数	硬膜外麻醉	全身麻醉	局部麻醉	平均手术时间(min)	治疗费用(元)	术后住院时间(d)
A组	30	24(80.00)	3(10.00)	3(10.00)	40±9	7547±133	2.17±0.42
B组	30	21(70.00)	5(16.67)	4(13.33)	33±7	9322±155	2.01±0.35
t/χ²		-			-3.36	47.60	-1.60
P值		0.0625^*			0.0014	<0.0001	0.1144

表3 2组患者术后情况比较[例（%）]

组别	例数	血清肿(术后7 d)	疼痛视觉模拟评分(±s)				补片感染^△	局部不适或异物感^△	复发^△
组别	例数	血清肿(术后7 d)	术前	术后7 d	术后1个月	术后6个月	补片感染^△	局部不适或异物感^△	复发^△
A组	30	0	0.20±0.04	0.47±0.13	0.37±0.06	0.12±0.04	0	4(13.33)	0
B组	30	0	0.18±0.05	0.45±0.15	0.38±0.09	0.10±0.05	0	1( 3.33)	0
t/χ²			-1.710	0.552	-0.506	1.711		-
P值			0.0925	0.5852	0.6148	0.0925		0.1505^*

表3 2组患者术后情况比较[例（%）]

组别	例数	血清肿(术后7 d)	疼痛视觉模拟评分(±s)				补片感染^△	局部不适或异物感^△	复发^△
组别	例数	血清肿(术后7 d)	术前	术后7 d	术后1个月	术后6个月	补片感染^△	局部不适或异物感^△	复发^△
A组	30	0	0.20±0.04	0.47±0.13	0.37±0.06	0.12±0.04	0	4(13.33)	0
B组	30	0	0.18±0.05	0.45±0.15	0.38±0.09	0.10±0.05	0	1( 3.33)	0
t/χ²			-1.710	0.552	-0.506	1.711		-
P值			0.0925	0.5852	0.6148	0.0925		0.1505^*

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Study on lightweight polypropylene mesh versus self-adhesive mesh in Lichtenstein hernia repair

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Study on lightweight polypropylene mesh versus self-adhesive mesh in Lichtenstein hernia repair