补片固定与否对腹股沟疝经腹腹膜前修补术后患者并发症的影响

doi:10.3877/cma.j.issn.1674-392X.2024.04.009

目的

研究经腹腹膜前修补术（TAPP）补片固定与否对腹股沟疝患者术后并发症的影响。

方法

收集2019年5月18日至2023年3月30日就诊于中山大学附属第六医院、深圳市盐田区人民医院、深圳市坪山区人民医院的434例腹股沟疝患者的临床数据，依据术中补片固定与否分为补片固定组（95例）与补片不固定组（339例），统计学方法分析TAPP术补片固定与否对腹股沟疝患者术后疼痛评分、血清肿、切口感染、慢性疼痛及复发的影响。

结果

补片固定组疼痛评分为（2.05±0.755）分，补片不固定组疼痛评分为（1.06±0.600）分，补片固定组术后疼痛程度较补片不固定组强，差异有统计学意义（P<0.01）；血清肿及切口感染的发生率，补片固定组与补片不固定组差异无统计学意义（P>0.05）；术后慢性疼痛的发生率补片固定组为6.3%，高于补片不固定组2.1%，差异有统计学意义（P<0.05）；补片固定与否对TAPP术后1年的复发率没有影响，差异无统计学意义（P>0.05）。

结论

TAPP术补片固定与否不影响早期疝复发，补片固定会增加术后疼痛及慢性疼痛的发生率。因此，对于一般的腹股沟疝而言，TAPP术中无需进行网片固定。

关键词: 疝，腹股沟, 经腹腹膜前修补术, 网片固定, 并发症, 复发

Objective

To investigate the effect of mesh fixation after TAPP surgery on postoperative complications in patients with inguinal hernia.

Methods

Clinical data of 434 patients with an inguinal hernia who visited the Sixth Affiliated Hospital of Sun Yat-sen University, Yantian District People's Hospital of Shenzhen, and Pingshan District People's Hospital of Shenzhen from May 18, 2019 to March 30, 2023 were collected. According to whether the mesh was fixed or not during the operation, they were divided into a fixed mesh group (95 cases) and a non-fixed mesh group (339 cases). Statistical methods were used to analyze the effects of mesh fixation during TAPP surgery on postoperative pain scores, serum swelling, incision infection, chronic pain, and recurrence in patients with inguinal hernia.

Results

The pain score of the fixed mesh group was 2.05±0.755, while the pain score of the non-fixed mesh group was 1.06±0.600. The postoperative pain level of the fixed mesh group was stronger than that of the non-fixed mesh group, and the difference was statistically significant (P<0.01). There was no statistically significant difference in the incidence of serum swelling and incision infection between the fixed mesh group and the non-fixed mesh group (P>0.05); The incidence of postoperative chronic pain in the fixed mesh group was 6.3%, while in the non-fixed mesh group it was 2.1%. The incidence of postoperative chronic pain in the fixed mesh group was higher than that in the non-fixed mesh group, and the difference was statistically significant (P<0.05). The presence or absence of mesh fixation did not affect the 1-year recurrence rate of TAPP surgery, and the difference was not statistically significant (P>0.05).

Conclusion

Mesh fixation or not during TAPP surgery does not affect early hernia recurrence, and mesh fixation increases the incidence of postoperative pain and chronic pain. Therefore, for general hernias, mesh fixation is not required during TAPP surgery.

Key words: Hernia, inguinal, Transabdominal preperitoneal repair surgery, Mesh fixation, Complications, Recrudescence

表1 2组行腹腔镜经腹腹膜前腹股沟疝修补术患者的一般资料比较

组别	例数	年龄(岁,±s)	单双侧[例(%)]		^*直疝/斜疝[例(%)]		阴囊疝[例(%)]	关闭缺损[例(%)]
组别	例数	年龄(岁,±s)	单侧	双侧	直疝	斜疝	阴囊疝[例(%)]	关闭缺损[例(%)]
补片固定组	95	55.32±14.155	67(70.5)	28(29.5)	39(34.5)	74(65.4)	12(12.6)	25(26.3)
补片不固定组	339	59.53±18.022	271(79.9)	68(20.1)	117(33.2)	235(66.8)	30(9.0)	111(33.0)
t/χ²值		-3.125	3.818		0.062		0.002	1.937
P值		0.002	0.051		0.803		0.969	0.164

表1 2组行腹腔镜经腹腹膜前腹股沟疝修补术患者的一般资料比较

组别	例数	年龄(岁,±s)	单双侧[例(%)]		^*直疝/斜疝[例(%)]		阴囊疝[例(%)]	关闭缺损[例(%)]
组别	例数	年龄(岁,±s)	单侧	双侧	直疝	斜疝	阴囊疝[例(%)]	关闭缺损[例(%)]
补片固定组	95	55.32±14.155	67(70.5)	28(29.5)	39(34.5)	74(65.4)	12(12.6)	25(26.3)
补片不固定组	339	59.53±18.022	271(79.9)	68(20.1)	117(33.2)	235(66.8)	30(9.0)	111(33.0)
t/χ²值		-3.125	3.818		0.062		0.002	1.937
P值		0.002	0.051		0.803		0.969	0.164

表2 2组行腹腔镜经腹腹膜前腹股沟疝修补术患者的术后疼痛评分及并发症发生率比较

组别	例数	疼痛评分(分,±s)	血清肿[例(%)]	切口感染[例(%)]	慢性疼痛[例(%)]	术后复发[例(%)]
补片固定组	95	2.05±0.755	3(3.2)	0(0.0)	6(6.3)	0(0.0)
补片不固定组	339	1.06±0.600	15(4.4)	2(0.6)	7(2.1)	1(0.3)
t/χ²/Fisher值		13.479	0.300	0.563	4.615	0.563
P值		<0.001	0.584	0.453	0.032	0.453

表2 2组行腹腔镜经腹腹膜前腹股沟疝修补术患者的术后疼痛评分及并发症发生率比较

组别	例数	疼痛评分(分,±s)	血清肿[例(%)]	切口感染[例(%)]	慢性疼痛[例(%)]	术后复发[例(%)]
补片固定组	95	2.05±0.755	3(3.2)	0(0.0)	6(6.3)	0(0.0)
补片不固定组	339	1.06±0.600	15(4.4)	2(0.6)	7(2.1)	1(0.3)
t/χ²/Fisher值		13.479	0.300	0.563	4.615	0.563
P值		<0.001	0.584	0.453	0.032	0.453

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Study of mesh fixation during TAPP on postoperative complications in patients with inguinal hernia

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Study of mesh fixation during TAPP on postoperative complications in patients with inguinal hernia