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中华疝和腹壁外科杂志(电子版) ›› 2024, Vol. 18 ›› Issue (06) : 629 -633. doi: 10.3877/cma.j.issn.1674-392X.2024.06.007

论著

Gilbert 与单层补片腹膜前疝修补术疗效的随机对照研究
马东扬1, 李斌1, 陆安清1, 王光华1, 雷文章1, 宋应寒,2   
  1. 1.610041 成都,四川大学华西医院胃肠疝外科
    2.610041 成都,四川大学华西医院日间手术中心
  • 收稿日期:2024-10-28 出版日期:2024-12-18
  • 通信作者: 宋应寒
  • 基金资助:
    四川大学华西医院院内课题(HX-H2307201)

Randomized controlled trial on the curative effect of the Gilbert procedure and single mesh preperitoneal hernia repair

Dongyang Ma1, Bin Li1, Anqing Lu1, Guanghua Wang1, Wenzhang Lei1, Yinghan Song,2   

  1. 1.Department of Gastrointestinal Hernia, West China Hospital,Sichuan University, Chengdu 610041, China
    2.Day Surgery Center, West China Hospital,Sichuan University, Chengdu 610041, China
  • Received:2024-10-28 Published:2024-12-18
  • Corresponding author: Yinghan Song
引用本文:

马东扬, 李斌, 陆安清, 王光华, 雷文章, 宋应寒. Gilbert 与单层补片腹膜前疝修补术疗效的随机对照研究[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 629-633.

Dongyang Ma, Bin Li, Anqing Lu, Guanghua Wang, Wenzhang Lei, Yinghan Song. Randomized controlled trial on the curative effect of the Gilbert procedure and single mesh preperitoneal hernia repair[J/OL]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2024, 18(06): 629-633.

目的

比较局部麻醉下双层补片无张力疝修补手术(Gilbert 手术)和单层补片腹膜前无张力疝修补手术治疗成人腹股沟疝的效果。

方法

采用前瞻性、单中心、单盲、随机对照的临床试验方法,将2021 年2 月至2022 年2 月四川大学华西医院收治的630 例患者通过计算机辅助简单随机法分为双层补片组(采用双层补片无张力疝修补术)和单层补片组(采用单层补片腹膜前无张力疝修补术),观察2 组患者的手术时长、术后感染、术后疼痛、复发率等情况。

结果

随访至2024 年10 月,3 例患者失访。单层补片组(n=314)的手术时间少于双层补片组(n=313)[(24.92±4.87)min 比(26.93±4.89)min,t=5.153,P<0.001];单层补片组在出院时、术后1 周及1 个月活动时疼痛视觉模拟评分低于双层补片组,差异均有统计学意义(P<0.001)。术后切口渗血双层补片组2例、单层补片组3 例,阴囊血清肿双层补片组8 例、单层补片组10 例,差异均无统计学意义(P=1.000,P=0.812);2 组患者的复发率、感染后取出补片率、慢性疼痛比较,差异均无统计学意义(P>0.05)。

结论

两种手术方案均具有可行性,单层补片腹膜前修补术能简化手术流程,减少手术时间,降低术后短期疼痛程度,提高治疗的整体效果,为患者提供更多的治疗选择。

Objective

To compare the effect of double-layer mesh tension-free hernia repair surgery (Gilbert operation) and single-layer mesh preperitoneal tension-free hernia repair surgery in the treatment of adult inguinal hernia.

Methods

A prospective, single-center, single-blind, randomized controlled clinical trial was conducted.A total of 630 patients who admitted to West China Hospital,Sichuan University from February 2021 to February 2022 were divided into the double-layer mesh group(who underwent double-layer mesh tension-free hernia repair surgery) and the single-layer mesh group(who underwent single-layer mesh preperitoneal tension-free hernia repair surgery) by computer-assisted simple randomization.Operative time, the incidence of postoperative infection, postoperative pain, and recurrence rate were observed in the two groups.

Results

A total of 3 patients were lost to follow-up until October 2024.The single-layer mesh group (n=314) had shorter operation time than that of the double-layer mesh group (n=313) [(24.92±4.87) min vs.(26.93±4.89) min, t=5.153, P<0.001].The visual analogue scale scores of pain during activity of the single-layer mesh group were lower than those of the double-layer mesh group at discharge, 1 week and 1 month after surgery, and the differences were all statistically significant (P<0.001).There were 2 cases of postoperative cutaneous hematoma in the double-layer mesh group and 3 cases in the single-layer mesh group.There were 8 cases of scrotal seroma in the double-layer mesh group and 10 cases in the single-layer mesh group.There were no significant differences between the two groups (P=1.000, P=0.812).There was no significant difference in the recurrence rate, mesh removal rate after infection, and chronic pain between the two groups (P>0.05).

Conclusion

Both surgical procedures are feasible.The single-layer mesh preperitoneal repair surgery can simplify the surgical procedure, reduce the operation time, and reduce the degree of postoperative short-term pain, thereby improving the overall treatment effect and providing more treatment options for patients.

图1 患者纳入及随访流程
表1 2 组患者的一般资料比较
表2 2 组患者的术中资料比较
表3 2 组患者术后不同时间活动时疼痛视觉模拟评分比较[分,MQ1, Q3)]
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