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中华疝和腹壁外科杂志(电子版) ›› 2023, Vol. 17 ›› Issue (04) : 432 -436. doi: 10.3877/cma.j.issn.1674-392X.2023.04.014

论著

经腹腹膜前疝修补术与李金斯坦术对原发性腹股沟疝的疗效比较
周晓华, 芮鸿庆, 徐光齐, 王礽, 濮阳永强, 孔荷香()   
  1. 211300 南京市高淳人民医院普通外科
  • 收稿日期:2023-02-13 出版日期:2023-08-18
  • 通信作者: 孔荷香

Comparison of the clinical efficacy of transabdominal preperitoneal hernia repair and Lichtenstein hernia repair in the treatment of primary inguinal hernia

Xiaohua Zhou, Hongqing Rui, Guangqi Xu, Reng Wang, Yongqiang Puyang, Hexiang Kong()   

  1. Department of General Surgery, Nanjing Gaochun People's Hospital, Nanjing 211300, China
  • Received:2023-02-13 Published:2023-08-18
  • Corresponding author: Hexiang Kong
引用本文:

周晓华, 芮鸿庆, 徐光齐, 王礽, 濮阳永强, 孔荷香. 经腹腹膜前疝修补术与李金斯坦术对原发性腹股沟疝的疗效比较[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(04): 432-436.

Xiaohua Zhou, Hongqing Rui, Guangqi Xu, Reng Wang, Yongqiang Puyang, Hexiang Kong. Comparison of the clinical efficacy of transabdominal preperitoneal hernia repair and Lichtenstein hernia repair in the treatment of primary inguinal hernia[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2023, 17(04): 432-436.

目的

比较分析腹腔镜经腹腹膜前疝修补术(TAPP)与李金斯坦(Lichtenstein)疝修补术治疗成人原发性腹股沟疝的疗效,为基层医师选择合适的手术方式提供临床依据。

方法

回顾性收集2019年1月至2020年1月,南京市高淳人民医院普通外科收治的80例成人原发性腹股沟疝患者的临床资料。按照手术方式的不同将患者分为两组:试验组行TAPP,对照组行Lichtenstein术,各40例。对比两组患者围手术期相关指标(手术时间、术中出血量、住院时间、住院费用)、术后24 h疼痛评分、术后并发症(血清肿、尿潴留、手术部位感染、慢性疼痛)和复发情况。

结果

两组患者一般资料具有可比性。术后试验组与对照组分别平均随访(20.6±3.3)个月和(21.4±2.1)个月。试验组术中出血量(7.35±1.31)ml、住院时间(3.13±0.72)d、术后24 h疼痛评分(1.63±0.54)分、腹股沟区慢性疼痛发生率2.5%,均低于对照组[(11.95±1.01)ml、(4.68±0.62)d、(2.65±0.62)分、20.0%](P<0.05)。试验组手术时间(73.65±6.14)min、住院费用(10 688.55±2624.58)元、尿潴留发生率20%,均明显高于对照组[(40.78±6.7)min、(6390.50±988.77)元、2.5%](P<0.05)。两组其他指标比较差异无统计学意义。

结论

TAPP是一种安全、可行的术式,与Lichtenstein术相比术中出血量少、术后24 h疼痛程度轻、住院时间短、术后慢性疼痛的发生率低,但花费较高,手术时间较长。临床上要具体病例具体分析,采取个体化的手术方式。

Objective

To compare and analyze the efficacy of laparoscopic transabdominal preperitoneal hernia repair (TAPP) and Lichtenstein hernia repair in the treatment of primary inguinal hernia in adults, and to provide a clinical basis for primary care physicians to choose the appropriate surgical approach.

Methods

The clinical data of 80 adult primary inguinal hernia patients admitted to the Department of General Surgery of Gaochun People's Hospital in Nanjing from January 2019 to January 2020 were retrospectively collected. The patients were divided into two groups according to the operation mode: the experimental group underwent TAPP, and the control group underwent Lichtenstein hernia repair, with 40 cases in each group. The perioperative related indexes (operation time, intraoperative bleeding, hospitalization time, hospitalization cost), postoperative 24 h pain score, postoperative complications (seroma, urinary retention, infectionat the surgical site, chronic pain), and recurrence were compared between the two groups.

Results

The general data of the two groups of patients were comparable. The average follow-up time was (20.6±3.3) months in the experimental group and (21.4±2.1) months in the control group.. Intraoperative bleeding (7.35±1.31) ml, length of hospitalization (3.13±0.72) d, postoperative 24-h pain score (1.63±0.54), and incidence of chronic pain in the inguinal region (2.5%) in the experimental group were less than those in the control group [(11.95±1.01) ml、(4.68±0.62) d、(2.65±0.62)、20.0%], (P<0.05). The experimental group's operation time (73.65±6.14) min was significantly longer than that of the control group (40.78±6.7) min (P<0.05). The cost of the experimental group during hospitalization (10 688.55±2624.58) yuan, the incidence of urinary retention (20%) was significantly higher than that of the control group [(6390.50±988.77) yuan、2.5%] (P<0.05); and the difference of other indexes between the two groups was not statistically significant.

Conclusion

TAPP is a safe and feasible surgical procedure, and compared with Lichtenstein hernia repair, it can reduce intraoperative bleeding, postoperative 24 h pain score, hospitalization time, and the incidence of postoperative chronic pain, but the cost is higher and the operation time is longer. Clinically, a case-by-case analysis is required to adopt an individualized surgical approach.

表1 两组患者人口统计学特征[例(%)]
表2 两组患者围手术期相关指标及术后24 h疼痛评分比较(±s
表3 两组患者术后并发症相关指标比较[例(%)]
[1]
LeBlanc K, Kingsnorth A. Hernias: inguinal and incisional[J]. Lancet, 2003, 362: 1561-1571.
[2]
唐健雄. 腹股沟疝无张力修补手术的规范化问题[J]. 中华普通外科杂志, 2011, 26(2): 89-90.
[3]
中华医学会外科学分会疝与腹壁外科学组, 中国医师协会外科医师分会疝和腹壁外科医师委员会. 成人腹股沟疝诊疗指南(2014年版)[J/OL]. 中华疝和腹壁外科杂志(电子版), 2014, 8(3): 204-206.
[4]
Shah NR, Mikami DJ, Cook CA, et al. Comparison of outcomes between open and laparoscopic surgical repair of re-current inguinal hernias[J]. Surg Endosc, 2011, 25: 2330-2337.
[5]
Hernia Surge Group. International guidelines for groin hernia management[J]. Hernia, 2018, 22(1): 1-165.
[6]
高万露, 汪小海. 患者疼痛评分法的术前选择及术后疼痛评估的效果分析[J]. 实用医学杂志, 2013, 29(23): 3892-3894.
[7]
沈毅. 腹腔镜完全腹膜外疝修补术(TEP)治疗老年人腹股沟疝(≥60岁)的临床疗效[D]. 沈阳: 中国医科大学, 2022.
[8]
张群. 腹腔镜下完全腹膜外疝修补术与经腹腔腹膜前疝修补术的临床效果比较[J]. 中国医药指南, 2016, 14(7): 165.
[9]
方丽莉, 陆建平, 李绍杰, 等. 完全腹膜外腹腔镜腹股沟疝修补术中电外科器械无电输出的特殊病例及实验(附1例报告)[J]. 外科理论与实践, 2021, 26(5): 449-451.
[10]
李炜宇, 赵蕾. 开放式无张力疝修补术与腹腔镜疝修补术在治疗成人腹股沟疝的临床疗效比较[J/OL]. 中华疝和腹壁外科杂志(电子版), 2017, 11(4): 302-303.
[11]
Wang WJ, Chen JZ, Fang Q, et al. Comparison of the effects of laparoscopic hernia repair and Lichtenstein tension-free hernia repair[J]. J Laparoendosc Adv Surg Tech A, 2013, 23(4): 301-305.
[12]
Pisanu A, Podda M, Saba A, et al. Meta-analysis and review of prospective randomized trials comparing laparoscopic and Lichtenstein techniques in recurrent inguinal hernia repair[J]. Hernia, 2015, 19(3): 355-366.
[13]
Ielpo B, Duran H, Diaz E, et al. A prospective randomized study comparing laparoscopic transabdominal preperitoneal(TAPP) versus Lichtenstein repair for bilateral inguinal hernias[J]. Am J Surg, 2018, 216(1): 78-83.
[14]
贾传新, 吕亮宏, 吕忠船. 腹腔镜经腹腹膜前疝修补术与李金斯坦术治疗成人腹股沟疝的临床对比研究[J]. 腹腔镜外科杂志, 2020, 25(5): 386-388.
[15]
El-DhuwaibY, Corless D, Emmett C, et al. Laparoscopic versus open repair of inguinal hernia: a longitudinal cohort study[J]. Surg Endosc, 2013, 27: 936-945.
[16]
Abbas AE, AbdEllatif ME, Noaman N, et al. Patient-perspective quality of life after laparoscopic and open hernia repair: a controlled randomized trial[J]. Surg Endosc, 2012, 26(9): 2465-2470.
[17]
Miserez M, Peeters E, Aufenacker T, et al. Update with level 1 studies of the European Hernia Society guidelines on the treatment of inguinal hernia in adult patients[J]. Hernia, 2014, 18(2): 151-163.
[18]
Berger D. Evidence-Based Hernia Treatment in Adults[J]. Dtsch Arztebl Int, 2016, 113(9): 150-157.
[19]
Mulroy MF. Hernia surgery, anesthetic technique, and urinary retention-apples, oranges, and kumquats?[J]. RegAnesth Pain Med, 2002, 27: 587-589.
[20]
Vasileff WK, Nekhline M, Kolowich PA, et al. Inguinal hernia in athletes: role of dynamic ultrasound[J]. Sports Health, 2017, 9(5): 414-421.
[21]
吕燕利, 吴玲利, 张玲. 以多学科团队合作为基础的快速康复外科在腹股沟疝修补术患者中的应用效果分析[J]. 齐齐哈尔医学院学报, 2019, 40(2): 252-253.
[22]
汪波, 刘勇, 蔡逊. 腹腔镜下腹股沟疝修补术后尿潴留发生的危险因素分析[J]. 腹部外科, 2016, 29(2): 127-129.
[23]
Leung D, Ujiki MB. Minimally invasive approaches to inguinal hernia repair[J]. J Long Term Eff Med Implants, 2010, 20(2): 105-116.
[24]
中华医学会外科学分会疝与腹壁外科学组, 中国医师协会外科医师分会疝和腹壁外科医师委员会. 成人腹股沟疝诊断和治疗指南(2018年版)[J]. 中华外科杂志, 2018, 56(7): 495-498.
[25]
Nikkolo C, Lepner U. Chronic pain after open inguinal hernia repair[J]. Postgrad Med, 2016, 128(1): 69-75.
[26]
杨福全. 腹壁疝修补术后疼痛预防及处理[J]. 中国实用外科杂志, 2020, 40(7): 778-780.
[27]
Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention[J]. Lancet, 2006, 367: 1618-1625.
[28]
Simons MP, Aufenacker T, Bay-Nielsen M, et al. European Hernia Society guidelines on the treatment of inguinal hernia in adult patients[J]. Hernia, 2009, 13: 343-403.
[29]
Scheuermann U, Niebisch S, Lyros O, et al. Transabdominal Preperitoneal(TAPP) versus Lichtenstein operation for primary inguinal hernia repair-A systematic review and meta-analysis of randomized controlled trials[J]. BMC Surg, 2017, 17(1): 55.
[30]
段先召, 王婉东, 陈洪流. 腹股沟疝修补术后慢性疼痛的最新研究进展[J]. 世界最新医学信息文摘, 2018, 18(72): 78-80.
[31]
Hu QL, Chen DC. Approach to the Patient with Chronic Groin Pain[J]. Surg Clin North Am, 2018, 98(3): 651-665.
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