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中华疝和腹壁外科杂志(电子版) ›› 2024, Vol. 18 ›› Issue (02) : 197 -201. doi: 10.3877/cma.j.issn.1674-392X.2024.02.014

论著

腹腔镜下关闭Ⅲ型腹股沟斜疝内环联合补片修补的临床疗效
罗彬予1, 张肖1, 郭庆1, 喻晶1, 张大权1, 李权林1, 周冬兵1, 田云鸿1, 任明扬1,†()   
  1. 1. 637000　四川，川北医学院第二临床医学院·南充市中心医院胃肠疝外科
  • 收稿日期:2022-08-19 出版日期:2024-04-18
  • 通信作者: 任明扬

Clinical efficacy of laparoscopic closure of internal ring combined with mesh repair for typeⅢ indirect inguinal hernia

Binyu Luo1, Xiao Zhang1, Qing Guo1, Jing Yu1, Daquan Zhang1, Quanlin Li1, Dongbing Zhou1, Yunhong Tian1, Mingyang Ren1,†()   

  1. 1. Department of Gastrointestinal Surgery, Affiliated Nanchong Central Hospital & The Second Clinical Medical College of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
  • Received:2022-08-19 Published:2024-04-18
  • Corresponding author: Mingyang Ren
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引用本文：

罗彬予, 张肖, 郭庆, 喻晶, 张大权, 李权林, 周冬兵, 田云鸿, 任明扬. 腹腔镜下关闭Ⅲ型腹股沟斜疝内环联合补片修补的临床疗效[J]. 中华疝和腹壁外科杂志(电子版), 2024, 18(02): 197-201.

Binyu Luo, Xiao Zhang, Qing Guo, Jing Yu, Daquan Zhang, Quanlin Li, Dongbing Zhou, Yunhong Tian, Mingyang Ren. Clinical efficacy of laparoscopic closure of internal ring combined with mesh repair for typeⅢ indirect inguinal hernia[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2024, 18(02): 197-201.

目的

探讨腹腔镜下关闭Ⅲ型腹股沟斜疝内环联合补片修补手术的临床疗效。

方法

采用前瞻性随机对照研究方式，将2020年5月至2021年12月，川北医学院附属南充市中心医院收治的193例Ⅲ型腹股沟斜疝患者随机分为内环关闭试验组（93例）和未关闭对照组（100例），比较2组患者手术时间、术后住院时间、术后疼痛视觉模拟评分（VAS）、血清肿及血清肿积液量、住院费用、并发症及复发情况等。

结果

试验组在术后7 d[32（34.4%）比63（63.0%）]、14 d[16（17.2%）比35（35.0%）]、21 d[6（6.5%）比20（20.0%）]血清肿发生比率低于对照组，差异均有统计学意义（P<0.01）；对照组在术后7 d[（36.44±16.57）ml比（45.44±15.27）ml]、14 d[（23.88±9.20）ml比（32.23±8.87）ml ]出现血清肿积液量高于试验组，差异均有统计学意义（P<0.05）。对照组在术后7 d[39（41.9%）比60（60.0%）]、14 d[17（18.2%）比33（33.0%）]、21 d[6（6.4%）比22（22.0%）]疼痛患者例数占比明显高于试验组，差异均有统计学意义（P<0.05）；对照组在术后7 d[（1.95±0.71）分比（2.37±0.62）分]、14 d [（1.65±0.49）分比（2.12±0.49）分]VAS评分高于试验组，差异均有统计学意义（P<0.05）；试验组手术时间长于对照组[（64.1±12.1）min比（54.9±9.7）min]，差异有统计学意义（P<0.05）；2组住院时间、总住院费用及术后并发症（尿潴留、肠梗阻、恶心、呕吐、出血及感染）发生率比较，差异均无统计学意义（P>0.05）。术后随访时间3～20个月，2组患者随访期间均未出现慢性疼痛及复发。

结论

腹腔镜下缝合关闭Ⅲ型斜疝内环缺损是安全并有效的，可显著减少术后血清肿发生率，并进一步减轻术后疼痛，且不增加术后感染、复发等风险。

关键词: 腹腔镜, Ⅲ型腹股沟斜疝, 补片, 关闭疝环, 血清肿, 术后疼痛
Objective

To investigate the clinical efficacy of laparoscopic closure of internal ring combined with mesh repair for type Ⅲ indirect inguinal hernia.

Methods

In this prospective randomized controlled study, 193 patients with type Ⅲ indirect inguinal hernia admitted to Nanchong Central Hospital Affiliated to North Sichuan Medical College from May 2020 to December 2021 were randomly divided into the experimental group (close internal ring, 93 cases) and the control group (not close internal ring, 100 cases). The operation time, postoperative hospital stays, postoperative pain visual analogue scale (VAS) score, seroma and seroma fluid volume, hospitalization cost, complications and recurrence were compared between the two groups.

Results

The incidence of seroma in the experimental group was lower than that in the control group on the 7 d [32(34.4%) vs 63 (63.0%)], 14 d [16(17.2%) vs 35 (35.0%)], 21 d [6(6.5%) vs 20 (20.0%)] after operation, and the difference was statistically significant (P<0.01). The seroma fluid volume in the control group was higher than that in the experimental group on the 7 d [(36.44±16.57) ml vs (45.44±15.27) ml] and 14 d [(23.88±9.20) ml vs (32.23±8.87) ml] days after operation, and the difference was statistically significant (P<0.05). The number of patients with pain in the control group was significantly higher than that in the experimental group at 7 d [39(41.9%) vs 60(60.0%)]、14 d [17(18.2%) vs 33(33.0%)]、21 d [6(6.4%) vs 22(22.0%)] after operation, and the difference between the two groups was statistically significant (P<0.05). The VAS score in the control group was higher than that in the experimental group at 7 d [(1.95±0.71) points vs (2.37±0.62) points] and 14 d [(1.65±0.49) points vs (2.12±0.49) points] after operation, and the difference between the two groups was statistically significant (P<0.05). The operation time in the experimental group was longer than that in the control group [(64.1±12.1) min vs (54.9±9.7) min], and the difference was statistically significant (P<0.05). There was no significant difference between the two groups in the length of stay, total hospitalization cost and incidence of postoperative complications (urinary retention, intestinal obstruction, nausea, vomiting, bleeding and infection) (P>0.05). The postoperative follow-up time ranged from 3 to 20 months. No chronic pain or recurrence occurred in both groups during the postoperative follow-up.

Conclusion

Laparoscopic closure of the internal ring defect of type Ⅲ indirect hernia is safe and effective, which can significantly reduce the incidence of postoperative seroma and further reduce postoperative pain without increasing the risk of postoperative infection and recurrence.

Key words: Laparoscopes, Type Ⅲ indirect inguinal hernia, Mesh, Closed hernia ring, Seroma, Postoperative pain
图1 内环口关闭前
图2 内环口缝合关闭中
图3 关闭内环口后
表1 2组患者一般资料比较
组别 例数 年龄(岁,±s) 体重指数(kg/m2,±s) 病程(月,±s) 基础疾病[例(%)] 侧位[例(%)] 内环直径(cm,±s) 疝囊大小(cm,±s)
高血压 糖尿病 慢性阻塞性肺疾病 左侧 右侧]
试验组 93 64.6±14.2 23.9±3.1 59.8±99.4 18(19.4) 14(15.1) 7(7.5) 16(17.2) 77(82.8) 3.5±0.7 8.9±2.1
对照组 100 66.0±11.4 23.5±2.9 40.4±79.2 19(19.0) 18(18.0) 13(13.0) 19(19.0) 81(81.0) 3.5±0.7 9.3±2.0
t/χ2值   0.749 0.956 1.497 0.004 0.302 1.554 0.105 0.034 1.33
P值   0.455 0.34 0.136 0.95 0.582 0.213 0.746 0.973 0.185
表2 2组患者术中及近期术后评价比较
组别 例数 手术方式[例(%)] 横断疝囊[例(%)] 出血量(ml,±s) 手术时间(min,±s) 术后住院时间(d,±s) 住院费用(元,±s) 术后近期并发症[例(%)]
TEP TAPP 是 否 尿潴留 肠梗阻 恶心呕吐 切口出血 补片感染
试验组 93 17(18.3) 76(81.7) 78(83.9) 15(16.1) 3.5±4.6 64.1±12.1 2.2±1.4 12 882.8±914.4 11(11.8) 4(4.3) 2(2.2) 4(4.3) 0(0.0)
对照组 100 24(24.0) 76(76.0) 87(87.0) 13(13.0) 4.0±4.1 54.9±9.7 2.5±2.0 12 622.5±1090.8 20(20.0) 3(3.0) 3(3.0) 3(3.0) 0(0.0)
t/χ2值   0.942 0.380 0.78 5.868 1.129 1.790 2.387 0.233 0.138 0.233 -
P值   0.332 0.537 0.430 <0.01 0.260 0.075 0.122 0.629 0.710 0.629 -
表3 2组患者术后疼痛例数占比比较[例（%）]
组别 例数 1 d 7 d 14 d 21 d 28 d 3个月 6个月 12个月
试验组 93 68(73.1) 39(41.9) 17(18.2) 6(6.4) 5(5.3) 1(1.1) 0(0.0) 0(0.0)
对照组 100 81(81.0) 60(60.0) 33(33.0) 22(22.0) 11(11.0) 2(2.0) 0(0.0) 0(0.0)
χ2值   1.701 6.294 5.440 9.392 2.004 - - -
P值   0.192 0.012 0.020 0.002 0.157 - - -
表4 2组患者术后疼痛视觉模拟评分比较（分，±s）
组别 例数 1 d 7 d 14 d 21 d 28 d
试验组 93 2.97±1.09 1.95±0.71 1.65±0.49 1.20±0.45 1.40±0.55
对照组 100 3.04±0.93 2.37±0.62 2.12±0.49 1.23±0.43 1.09±0.30
t值   0.42 3.124 3.259 0.127 1.476
P值   0.689 0.002 0.002 0.900 0.162
表5 2组患者术后血清肿发生率比较[例（%）]
组别 例数 7 d 14 d 21 d 28 d
试验组 93 32(34.4) 16(17.2) 6(6.5) 4(4.3)
对照组 100 63(63.0) 35(35.0) 20(20.0) 10(10.0)
χ2值   15.760 7.849 7.588 2.326
P值   <0.01 0.005 0.006 0.127
表6 2组患者术后血清肿积液量比较（ml，±s）
组别 例数 7 d 14 d 21 d 28 d
试验组 93 36.44±16.57 23.88±9.20 23.67±10.80 21.50±3.11
对照组 100 45.44±15.27 32.23±8.87 26.70±8.81 21.40±2.68
t值   2.640 3.085 0.703 0.061
P值   0.01 0.003 0.489 0.953
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