腹股沟疝日间手术腹腔镜全腹膜外疝修补术与Lichtenstein术对照研究

doi:10.3877/cma.j.issn.1674-392X.2024.01.011

目的

探讨腹股沟疝日间手术腹腔镜全腹膜外疝修补术（TEP）与Lichtenstein术的临床疗效和优缺点。

方法

采用回顾性病例对照研究方法，分析绍兴市人民医院2019年2月至2020年4月收治的原发单侧腹股沟疝日间手术患者300例临床资料，按手术方式分为TEP组（采用TEP手术）和开放组（采用Lichtenstein手术），各150例。观察2组手术时间、出血量、住院时间及费用、术后下床时间、术后24 h内疼痛评分及超敏C反应蛋白变化，随访术后疼痛程度及持续时间、术后并发症、复发率等情况。

结果

TEP组的平均手术时间、住院时间明显少于开放组[（35.3±11）min vs（44.5±12）min，（16.8±1.8）h vs （17.2±1.5）h]，差异均有统计学意义（P<0.05）。2组患者的出血量、住院费用比较，差异无统计学意义（P>0.05）。TEP组术后下床时间（4.3±1.1）h、术后24 h疼痛VAS评分（3.45±0.2）分及超敏C反应蛋白（12.73±2.09）mg/L明显优于开放组[（6.5±1.2）h、（4.86±0.3）分和（27.46±4.63）mg/L]，差异均有统计学意义（P<0.05）。2组患者均获随访，无失访病例。开放组术后疼痛VAS评分高于TEP组，且2组患者术后疼痛程度均随时间推移逐渐减轻，差异有统计学意义（F_时间=10.09，P_时间<0.001；F_组间=1.35，P_组间=0.018；F_交互=9.37，P_交互<0.001）。TEP组患者尿潴留发生率低于开放组，皮下气肿发生率高于对照组，差异均有统计学意义（P<0.05）。2组患者阴囊水肿和（或）阴囊积液、切口血肿发生率、疝复发率差异无统计学意义（P>0.05）。TEP组并发症总发生率低于开放组（9.33% vs 12.67%），差异有统计学意义（P<0.05）。

结论

TEP与Lichtenstein术治疗成人腹股沟疝疗效相当，但是TEP具有创伤小、术后恢复快等优点，更适合于日间手术的开展。

关键词: 疝，腹股沟, 腹腔镜, 疝修补术, 日间手术

Objective

To explore the clinical efficacy, advantages and disadvantages of two surgical methods (TEP and Lichtenstein surgery) for day surgery for inguinal hernia.

Methods

A retrospective case-control study method was used to analyze 300 patients with primary unilateral inguinal hernia day surgery in People's Hospital of Shaoxing from February 2019 to April 2020. They were divided into a laparoscopic total extraperitoneal hernia repair group (TEP group) and a Lichtenstein surgery group (open group) according to the surgical method, with 150 cases in each group. The operation time, blood loss, hospitalization time and cost, postoperative ambulation time, 24 h postoperative pain visual analogue scale (VAS) score and changes in highly sensitive C-reactive protein (hsCRP) of the two groups were observed. The pain level and duration, postoperative complications, recurrence rate of the two groups were followed up.

Results

Compared with the open group, the average operative time and hospital stay were shorter in the TEP group [(35.3±11) min vs (44.5±12) min, (16.8±1.8) h vs (17.2±1.5) h], with statistical significance (P<0.05). The blood loss and hospital costs showed no statistically significant differences between the two groups (P>0.05). Compared to the open group, the TEP group showed statistically significant differences in postoperative ambulation time and 24 h postoperatively pain VAS score, changes in hsCRP [(4.3±1.1) h, (3.45±0.2) scores, (12.73±2.09) mg/L vs. (6.5±1.2) h, (4.86±0.3) scores, (27.46±4.63) mg/L]. All patients were followed up, with no missing cases. The VAS score of postoperative pain in the open group was higher than that in the TEP group, and the level of postoperative pain gradually decreased over time in both groups, with statistical significance (F=10.09, P<0.001; F=1.35, P=0.018; F=9.37, P<0.001, in time, group, and interaction). Compared with the open group, the incidence of urinary retention was lower, and subcutaneous emphysema was higher in the TEP group, with statistical significance (P<0.05). There were no statistically significant differences in the incidence of scrotal edema and/or hydrocele, incision hematoma, and recurrence rate between the two groups of patients (P>0.05). The overall complication rate in the TEP group was lower than in the open group (9.33% vs 12.67%), with a statistically significant difference (P<0.05).

Conclusion

TEP and Lichtenstein surgery are equally effective in treating adult inguinal hernia, but TEP has the advantages of less trauma and faster postoperative recovery, making it more suitable for day surgery.

Key words: Hernia, inguinal, Laparoscopy, Hernia repair, Day surgery

表1 2组患者一般资料比较

组别	例数	年龄(岁,±s)	性别[例(%)]		中华医学会疝分型[例(%)]		体重指数(kg/m²,±s)	美国麻醉医师协会分级[例(%)]
组别	例数	年龄(岁,±s)	男性	女性	Ⅱ型	Ⅲ型	体重指数(kg/m²,±s)	Ⅰ级	Ⅱ级
TEP组	150	60±12	140(93.33)	10(6.67)	64(42.67)	86(57.33)	20.4±0.6	96(64.00)	54(36.00)
开放组	150	61±11	142(94.67)	8(5.33)	68(45.33)	82(54.67)	20.1±0.5	89(59.33)	61(40.67)
t/χ²		2.2	0.807		0.623		0.342	0.751
P		0.189	0.369		0.425		0.216	0.532

表1 2组患者一般资料比较

组别	例数	年龄(岁,±s)	性别[例(%)]		中华医学会疝分型[例(%)]		体重指数(kg/m²,±s)	美国麻醉医师协会分级[例(%)]
组别	例数	年龄(岁,±s)	男性	女性	Ⅱ型	Ⅲ型	体重指数(kg/m²,±s)	Ⅰ级	Ⅱ级
TEP组	150	60±12	140(93.33)	10(6.67)	64(42.67)	86(57.33)	20.4±0.6	96(64.00)	54(36.00)
开放组	150	61±11	142(94.67)	8(5.33)	68(45.33)	82(54.67)	20.1±0.5	89(59.33)	61(40.67)
t/χ²		2.2	0.807		0.623		0.342	0.751
P		0.189	0.369		0.425		0.216	0.532

表2 2组患者手术相关指标比较（±s）

组别	例数	手术时间(min)	出血量(ml)	住院时间(h)	住院费用(元)
TEP组	150	35.3±11	5±2	16.8±1.8	9317±1849
开放组	150	44.5±12	6±3	17.2±1.5	8759±1350
t		6.89	7.45	6.35	8.73
P		0.03	0.65	0.04	0.06

表2 2组患者手术相关指标比较（±s）

组别	例数	手术时间(min)	出血量(ml)	住院时间(h)	住院费用(元)
TEP组	150	35.3±11	5±2	16.8±1.8	9317±1849
开放组	150	44.5±12	6±3	17.2±1.5	8759±1350
t		6.89	7.45	6.35	8.73
P		0.03	0.65	0.04	0.06

表3 术后下床时间、术后VAS评分、hsCRP变化（±s）

组别	例数	术后下床时间(h)	术后24 h VAS评分	hsCRP(mg/L)
TEP组	150	4.3±1.1	3.45±0.2	12.73±2.09
开放组	150	6.5±1.2	4.86±0.3	27.46±4.63
t		6.89	21.3	8.35
P		0.02	0.006	0.02

表3 术后下床时间、术后VAS评分、hsCRP变化（±s）

组别	例数	术后下床时间(h)	术后24 h VAS评分	hsCRP(mg/L)
TEP组	150	4.3±1.1	3.45±0.2	12.73±2.09
开放组	150	6.5±1.2	4.86±0.3	27.46±4.63
t		6.89	21.3	8.35
P		0.02	0.006	0.02

表4 2组患者术后随访疼痛评分比较（±s）

组别	例数	术后1个月	术后3个月	术后6个月	术后12个月	术后24个月
TEP组	150	1.3±0.7	1.0±0.6	0.7±0.6	0.3±0.5	0.5±0.6
开放组	150	1.9±0.7	1.3±0.6	1.0±0.5	0.5±0.5	0.4±0.5
F		F_时间=10.09, F_组间=1.35, F_交互=9.37
P		P_时间<0.001, P_组间=0.018, P_交互<0.001

表4 2组患者术后随访疼痛评分比较（±s）

组别	例数	术后1个月	术后3个月	术后6个月	术后12个月	术后24个月
TEP组	150	1.3±0.7	1.0±0.6	0.7±0.6	0.3±0.5	0.5±0.6
开放组	150	1.9±0.7	1.3±0.6	1.0±0.5	0.5±0.5	0.4±0.5
F		F_时间=10.09, F_组间=1.35, F_交互=9.37
P		P_时间<0.001, P_组间=0.018, P_交互<0.001

表5 2组患者并发症发生率及疝复发率比较[例（%）]

组别	例数	尿潴留	皮下气肿	阴囊水肿或积液	切口血肿	并发症总发生率	疝复发
TEP组	150	2(1.33)	4(2.67)	6(4.00)	2(1.33)	14( 9.33)	1(0.67)
开放组	150	6(4.00)	0	9(6.00)	4(2.67)	19(12.67)	2(1.33)
χ²		0.23	-	0.12	-	0.45	-
P		0.03	0.02^*	0.36	0.07^*	0.006	0.56^*

表5 2组患者并发症发生率及疝复发率比较[例（%）]

组别	例数	尿潴留	皮下气肿	阴囊水肿或积液	切口血肿	并发症总发生率	疝复发
TEP组	150	2(1.33)	4(2.67)	6(4.00)	2(1.33)	14( 9.33)	1(0.67)
开放组	150	6(4.00)	0	9(6.00)	4(2.67)	19(12.67)	2(1.33)
χ²		0.23	-	0.12	-	0.45	-
P		0.03	0.02^*	0.36	0.07^*	0.006	0.56^*

[1]	Barber RM, Fullman N, Sorensen RJD, et al. Healthcare Access and Quality Index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990-2015: a novel analysis from the Global Burden of Disease Study 2015[J]. Lancet, 2017, 390(10091): 231-266.
[2]	Hagbevor I, Ali MA, Awuku GA. Closed non-suction drain placement as haematoma and seroma formation preventive measure post-nylon darn surgery for inguinoscrotal hernias in adults[J]. Hernia, 2022, 26(1): 123-130.
[3]	Mahadevan V. Essential Anatomy of Abdominal wall[M]// Kingsnorth AN, LeBlanc KA. Management of Abdominal Hernias. 4ed. London: Springer, 2013: 23-48.
[4]	Miserez M, Peeters E, Aufenacker T, et al. European Hernia Society guidelines on the treatment of inguinal hernia in adult patients[J]. Hernia, 2014, 13(3): 443-444.
[5]	Stabilini C, van Veenendaal N, Aasvang E, et al. Update of the international HerniaSurge guidelines for groin hernia management[J]. BJS open, 2023, 7(5): zrad080.
[6]	中国日间手术合作联盟疝和腹壁外科专业日间手术专家委员会, 《中华疝和腹壁外科杂志(电子版)》编辑委员会, 全国卫生产业企业管理协会疝和腹壁外科产业及临床研究分会, 等. 腹股沟疝日间手术规范化流程与标准中国专家指南(2023版)[J/OL]. 中华疝和腹壁外科杂志(电子版), 2023, 17(5): 497-503.
[7]	Aiolfi A, Cavalli M, Del Ferraro S, et al. Total extraperitoneal(TEP) versus laparoscopic transabdominal preperitoneal(TAPP) hernioplasty: systematic review and trial sequential analysis of randomized controlled trials[J]. Hernia, 2021, 25(5): 1147-1157.
[8]	唐健雄, 郑民华, 陈杰, 等. 腹腔镜腹股沟疝手术操作指南(2017版)[J/OL]. 中华疝和腹壁外科杂志(电子版), 2017, 11(11): 1238-1242.
[9]	孙一峰, 唐黎明, 马玉亮, 等. TEP对腹股沟疝患者的治疗效果及对炎症因子的影响[J]. 浙江创伤外科, 2019, 24(3): 432-434.
[10]	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.
[11]	Cao C, Shi X, Jin W, et al.. Clinical Data Analysis for Treatment of Adult Inguinal Hernia by TAPP or TEP[J]. Front Surg, 2022, 9: 900843.
[12]	Florin JL, Bianchi V, Wiggan DD. One surgeon's experience with r-TAPP: a retrospective analysis of 150 consecutive robotic inguinal hernia cases[J]. J Robot Surg, 2022, 16(5): 1151-1155.
[13]	Sejersen K, Havelka A, Salas PS, et al. Early Kinetics of Calprotectin in Plasma Following Inguinal Hernia Surgery[J]. Innate Immun, 2022, 28(1): 49-54.
[14]	Amid PK. The Lichtenstein repair in 2002: an overview of causes of recurrence after Lichtenstein tension-free hernioplasty[J]. Hernia, 2003, 7(1): 13-16.
[15]	Zhuang L, Li Y, He W, et al. Therapeutic efficacy of programmed spatial anatomy of the myopectineal orifice in total extraperitoneal hernioplasty: a retrospective study[J]. Scientific Reports, 2023, 13(1): 2711.
[16]	Fukuhara M, Onishi S, Yonemura Y, et al. A totally extraperitoneal approach for endoscopic resection of a congenital prepubic sinus through the pubic symphysis[J]. Surg Case Rep, 2021, 7(1): 165.
[17]	Posthuma JJ, Sandkuyl R, Sloothaak DA, et al. Transinguinal preperitoneal(TIPP) vs endoscopic total extraperitoneal(TEP) procedure in unilateral inguinal hernia repair: a randomized controlled trial[J]. Hernia, 2023, 27(1): 119-125.
[18]	Singh HKSI, Massey LH, Arulampalam T, et al. Chronic groin pain following inguinal hernia repair in the laparoscopic era: Systematic review and meta-analysis[J]. Am J Surg, 2022, 224(4): 1135-1149.
[19]	Choi YY, Kim Z, Hur KY. Swelling after laparoscopic total extraperitoneal repair of inguinal hernias: review of one surgeon’s experience in 1, 065 cases[J]. World J Surg, 2011, 35(1): 43-46.
[20]	Wu G, Shi D, Chen M, et al. Laparoscopic total extraperitoneal(TEP) inguinal hernia repair with preperitoneal closed-suction drainage reduced postoperative complications[J]. BMC Surg, 2023, 23(1): 1-9.

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A comparative study between total extraperitoneal herniorrhaphy and Lichtenstein surgery for inguinal hernia of day surgery

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A comparative study between total extraperitoneal herniorrhaphy and Lichtenstein surgery for inguinal hernia of day surgery