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^*

[1]	Lichtenstein IL, Shulman AG, Amid PK, et al. The tension-free hernioplasty[J]. Am J Surg, 1989, 157(2): 188-193.
[2]	Campanelli G, Pascual MH, Hoeferlin A, et al. Randomized, controlled, blinded trial of Tisseel/Tissucol for mesh fixation in patients undergoing Lichtenstein technique for primary inguinal hernia repair: results of the TIMELI trial[J]. Ann Surg, 2012, 255(4): 650-657.
[3]	Wijsmuller AR, van Veen RN, Bosch JL, et al. Nerve management during open hernia repair[J]. Br J Surg, 2007, 94(1): 17-22.
[4]	Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention[J]. Lancet, 2006, 367(9522): 1618-1625.
[5]	Amid PK, Lichtenstein IL. Long-term results and current status of Lichtenstein open tension-free hernioplasty[J]. Hernia, 1998, 2: 89-94.
[6]	Shah MY, Raut P, Wilkinson TRV, et al. Surgical outcomes of laparoscopic total extraperitoneal(TEP) inguinal hernia repair compared with Lichtenstein tension-free open mesh inguinal hernia repair: A prospective randomized study[J]. Medicine(Baltimore), 2022, 101(26): e29746.
[7]	Sultan AAEA, Abo Elazm HA, Omran H. Lichtenstein versus transabdominal preperitoneal(TAPP) inguinal hernia repair for unilateral non recurrent hernia: A multicenter short term randomized comparative study of clinical outcomes[J]. Ann Med Surg, 2022, 18(76): 103428.
[8]	Campanelli G. Chronic pain after inguinal hernia repair is a real risk and a major issue[J]. Hernia, 2022, 26(1): 1.
[9]	Rutegård M, Lindqvist M, Svensson J, et al. Chronic pain after open inguinal hernia repair: expertise-based randomized clinical trial of heavyweight or lightweight mesh[J]. Br J Surg, 2021, 108(2): 138-144.
[10]	Liu Y, Zhou M, Zhu X, et al. Risk and protective factors for chronic pain following inguinal hernia repair: a retrospective study[J]. J Anesth, 2020, 34(3): 330-337.
[11]	Stahlman S, Fan M. Incidence of inguinal hernia and repair procedures and rate of subsequent pain diagnoses, active component service members, U. S. Armed Forces, 2010-2019[J]. MSMR, 2020, 27(9): 11-16.
[12]	Chastan P. Tension-free open hernia repair using an innovative self-gripping semi-resorbable mesh[J]. Hernia, 2009, 13(2): 137-142.
[13]	Bruna Esteban M, Cantos Pallarés M, Artigues Sánchez De Rojas E. Use of adhesive mesh in hernioplasty compared to the conventional technique. Results of a randomised prospective study[J]. Cir Esp, 2010, 88(4): 253-258.
[14]	García Ureña MÁ, Hidalgo M, Feliu X, et al. Multicentric observational study of pain after the use of a self-gripping lightweight mesh[J]. Hernia, 2011, 15(5): 511-515.
[15]	Pedano N, Pastor C, Arredondo J, et al. Open tension-free hernioplasty using a novel lightweight self-gripping mesh: medium-term experience from two institutions[J]. Langenbecks Arch Surg, 2012, 397(2): 291-295.
[16]	Wang D, Zhang H, Lei T, et al. Randomized Trial Comparing Self-Gripping Mesh with Polypropylene Mesh in Female Lichtenstein Hernioplasty[J]. Am Surg, 2020, 86(2): 110-115.
[17]	Mellert LT, Cheung ME, Zografakis JG, et al. Laparoscopic Inguinal Hernia Repair Using ProGrip Self-Fixating Mesh: Technical Learning Curve and Mid-Term Outcomes[J]. Surg Technol Int, 2019, 15(2): 235-240.
[18]	Wang D, Jiang J, Fu Y, et al. The comparison of self-gripping mesh and conventional mesh in laparoscopic inguinal hernia repair: the results of meta-analysis[J]. Updates Surg, 2022, 74(3): 857-863.
[19]	Kohno S, Hasegawa T, Aoki H, et al. Analysis of risk factors for surgical site infection and postoperative recurrence following inguinal and femoral hernia surgery in adults[J]. Asian J Surg, 2022, 45(4): 1001-1006.
[20]	Pierides G, Scheinin T, Remes V, et al. Randomized comparison of self-fixating and sutured mesh in open inguinal hernia repair[J]. Br J Surg, 2012, 99(5): 630-636.
[21]	Kingsnorth A, Gingell-Littlejohn M, Nienhuijs S, et al. Randomized controlled multicenter international clinical trial of self-gripping Parietex™ ProGrip™ polyester mesh versus lightweight polypropylene mesh in open inguinal hernia repair: interim results at 3 months[J]. Hernia, 2012, 16(3): 287-294.

[1]	刘柏隆, 周祥福. 经阴道膀胱膨出前盆补片修补术 + 阴道后壁修补术[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2025, 19(01): 128-128.
[2]	曹能琦, 张恒, 郑立锋, 陶庆松, 嵇振岭. Ad-Hoc 自裁剪补片用于造口旁疝Sugarbaker 修补术[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 620-623.
[3]	皮尔地瓦斯·麦麦提玉素甫, 李慧灵, 艾克拜尔·艾力, 李赞林, 王志, 克力木·阿不都热依木. 生物补片修补巨大复发性腹壁切口疝临床疗效分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 624-628.
[4]	马东扬, 李斌, 陆安清, 王光华, 雷文章, 宋应寒. Gilbert 与单层补片腹膜前疝修补术疗效的随机对照研究[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 629-633.
[5]	王浩源, 汪海洋, 孙建明, 陈以宽, 祁小桐, 唐博. 腹腔镜与开放修补对肝硬化腹外疝患者肝功能及凝血的影响[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 654-659.
[6]	周正阳, 陈凯, 仇多良, 邵乐宁, 吴浩荣, 钟丰云. 腹腔镜腹股沟疝修补术后出血原因分析及处理[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 660-664.
[7]	顾熙, 徐子宇, 周澍, 张吴楼, 张业鹏, 林昊, 刘宗航, 嵇振岭, 郑立锋. 腹股沟疝腹膜前间隙无张力修补术后补片感染10 例报道[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 665-669.
[8]	宋俊锋, 张珍珍. 单侧初发性腹股沟斜疝老年患者经腹腹膜前疝修补术中残余疝囊腹直肌下缘固定效果评估[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 670-674.
[9]	高娟, 徐建庆, 闫芳, 丁盛华, 刘霞. Rutkow、TAPP、TEP 手术治疗单侧腹股沟疝患者的临床疗效及对血清炎症因子水平的影响[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 675-680.
[10]	于新峰, 曾琦, 后强, 徐浩, 操谢芳. 腹腔镜经腹腹膜前疝修补术和腹腔镜完全腹膜外疝修补术对成人腹股沟疝治疗效果及预后分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 681-686.
[11]	臧宇, 姚胜, 朱新勇, 戎世捧, 田智超. 低温等离子射频消融治疗腹壁疝术后补片感染的临床效果[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 687-692.
[12]	方辉强, 黄杰, 随冰琰. 腰方肌阻滞与腹横肌平面阻滞对腹股沟疝腹腔镜手术患者术后镇痛效果的影响[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 697-702.
[13]	朱佳琳, 方向, 贵诗雨, 黄丹, 周小雨, 郭文恺. 大鼠切口疝腹膜前间隙补片修补术后血清中VEGF 和Ang-1 的表达情况[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 703-707.
[14]	张晋伟, 董永红, 王家璇. 基于GBD2021 数据库对中国与全球老年人疝疾病负担和健康不平等的分析比较[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 708-716.
[15]	杨媛媛, 林贤超, 林荣贵, 陆逢春, 黄鹤光. 肌后/腹膜前补片修补巨大切口疝术后并发症防治[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 645-648.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

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

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

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