目的

观察无张力疝修补术治疗慢性肾功能衰竭（CRF）合并腹股沟疝患者的疗效及对肾功能的影响。

方法

选取2022 年1 月至2023 年5 月新疆维吾尔自治区人民医院收治CRF 合并腹股沟疝患者80 例，随机分为对照组及试验组，每组40 例。对照组采用开放无张力疝修补术治疗，试验组采用腹腔镜下无张力疝修补术治疗，比较2组手术相关指标、恢复持续非卧床腹膜透析时间、手术前后肾功能指标变化及并发症发生率。

结果

与对照组手术时间（54.28±5.92）min、下床活动时间（13.85±1.47）h、术后住院时间（4.77±1.65）d、术后出血量（6.34±0.92）ml、术后第2天视觉模拟评分法（VAS）评分（3.62±1.17）分比较，试验组手术时间（46.61±4.05）min、下床活动时间（9.26±1.04）h、术后住院时间（3.05±1.02）d 短（P＜0.05），术后出血量（5.31±0.75）ml、术后第2 天VAS 评分（2.35±1.06）分较低（P＜0.05）。2组分别于术后4、6 周开始计划性恢复腹膜透析。试验组恢复腹膜透析时间（31.28±4.05）d 较对照组（49.06±5.17）d 明显短（P＜0.05）。术后对照组血清肌酐（559.47±59.12）μmol/L、血尿酸（592.69±43.58）μmol/L、β2-微球蛋白（4.68±0.56）mg/L 较术前明显升高，试验组上述指标为（440.05±51.09）μmol/L、（511.33±67.43）μmol/L、（4.10±0.40）mg/L，均明显低于对照组（P＜0.05）。术后1、3、5 个月，2组健康状况调查量表评分较术前增高（P＜0.05），试验组分别为（64.11±7.04）分、（70.14±7.62）分、（75.36±7.92）分均高于对照组（59.34±6.85）分、（65.28±6.84）分、（70.21±7.16）分（P＜0.05）。术后试验组并发症总发生率10.00%较对照组27.50%低（P＜0.05）。

结论

与开放无张力疝修补术比较，腹腔镜下无张力疝修补术治疗CRF合并腹股沟疝患者有创伤小、恢复快和手术效果明显及肾功能保护等优势。

Objective

To observe the effect of tension-free hernia repair in the treatment of patients with chronic renal failure (CRF) complicated with inguinal hernia and the impact on renal function.

Methods

A total of 80 patients with CRF and inguinal hernia who were admitted to the Department of Nephrology at Xinjiang Uygur Municipal People's Hospital from January 2022 to May 2023 were selected. They were randomly assigned to the control group (n=40) and the observation group (n=40),receiving open tension-free hernia repair and laparoscopic tension-free hernia repair, respectively. The two groups were compared on surgery-related indicators, recovery time of continuous ambulatory peritoneal dialysis, changes in renal function indicators before and after surgery, and the incidence of complications.

Results

Surgery time, ambulation time and postoperative hospital stay of the observation group[(46.61±4.05) min, (9.26±1.04) h and (3.05±1.02) d] were shorter than those of the control group[(54.28±5.92) min, (13.85±1.47) h and (4.77±1.65) d] (P＜0.05). The postoperative bleeding volume and VAS score on 2nd day after surgery [(5.31±0.75) ml and (2.35±1.06) ml] were smaller and lower than those of the control group [(6.34±0.92) ml and (3.62±1.17) ml] (P＜0.05). The observation group began planned resumption of peritoneal dialysis at 4 weeks after surgery, while the control group began at 6 weeks after surgery. The recovery time of peritoneal dialysis in the observation group [(31.28±4.05) days] was shorter than that in the control group [(49.06±5.17) days] (P＜0.05). After surgery, only serum creatinine (SCr),blood uric acid (UA) and β2-microglobulin (β2-MG) in the observation group [(440.05±51.09) μmol/L,(511.33±67.43) μmol/L and (4.10±0.40) mg/L] were significantly lower than those in the control group[(559.47±59.12) μmol/L, (592.69±43.58) μmol/L and (4.68±0.56) mg/L] (P＜0.05). At 1 month, 3 months and 5 months after surgery, the SF-36 scores of both groups increased (P＜0.05), and scores of the observation group [(64.11±7.04), (70.14±7.62) and (75.36±7.92)] were higher than those of the control group [(59.34±6.85), (65.28±6.84) and (70.21±7.16)] (P＜0.05). The total incidence of postoperative complications in the observation group (10.00%) was lower than that in the control group (27.50%)(P＜0.05).

Conclusion

Compared with open tension-free hernia repair, laparoscopic tension-free hernia repair has more advantages in treating patients with CRF and inguinal hernia, such as small wounds, fast recovery, significant effects and protection effects on renal function.