目的

探究腹腔镜经腹腹膜前疝修补术（TAPP）和完全腹膜外疝修补术（TEP）对成人腹股沟疝的疗效及预后。

方法

回顾性分析2021 年6 月至2022 年11 月德驭医疗马鞍山总医院普外科收治的腹股沟疝患者的临床资料，根据接受术式不同，将其分为TAPP 组（接受TAPP 术治疗）与TEP 组（接受TEP 术治疗），通过倾向性匹配评分法（卡钳值设置0.02）排除基线资料混杂因素影响，最终2 组各获得患者60 例。对比2 组围手术期指标、并发症，术前及术后6、12、24 h 视觉模拟评分（VAS），术前、术后24 h 应激指标，术前、术后4 周男性患者精索静脉情况（精索静脉管径及精索静脉血流速度），以及术后12 个月复发率。

结果

TEP 组术中出血量、创口直径、手术时间、下床活动时间少于TAPP 组（P＜0.05），而2 组住院时间差异无统计学意义（P＞0.05）；TEP组并发症总发生率为3.33%（2/60），TAPP 组并发症总发生率为6.67%（4/60），差异无统计学意义（P＞0.05）；组间与时间对TEP 组与TAPP 组患者的VAS 评分存在交互作用（P＜0.05），组间、时间对VAS 主效应显著（P＜0.05）；术后24 h，2 组患者皮质醇（Cor）、醛固酮（ALD）、去甲肾上腺素（NE）水平高于术前（P＜0.05），TEP 组术后24 h Cor、ALD、NE 水平低于TAPP 组（P＜0.05）；术后4 周，2 组男性患者精索静脉管径高于术前（P＜0.05），TEP 组男性患者精索静脉管径低于TAPP组（P＜0.05），2 组男性患者精索静脉血流速度低于术前（P＜0.05），TEP 组男性患者精索静脉血流速度高于TAPP 组（P＜0.05）；术后12 个月，TEP 组总复发率（5.00%，3/60）与TAPP 组（1.67%，1/60）比较，差异无统计学意义（P＞0.05）。

结论

腹腔镜TAPP 术与TEP 术均可有效治疗腹股沟疝，并发症较少，但TEP 术创伤更小、恢复更快、对男性患者精索静脉影响更小，可酌情选择合适术式。

Objective

To explore the influence of laparoscopic trans-abdominal preperitoneal hernia repair (TAPP) and laparoscopic totally extra-peritoneal hernia repair (TEP) on the efficacy and prognosis of adults with inguinal hernia.

Methods

Data of patients with inguinal hernia admitted to department of general surgery of Deyu Medical Ma'anshan General Hospital from June 2021 to November 2022 were retrospectively analyzed.According to different surgical methods, they were divided into TAPP group (TAPP treatment) and TEP group (TEP treatment).The propensity matching score method (caliper value=0.02) was used to exclude the influence of confounding factors of baseline data.Finally, 60 patients were obtained in each group (P＞0.05).The perioperative indicators, complications, visual analogue scale(VAS) scores before surgery and at 6, 12 and 24 h after surgery, stress indicators before surgery and at 24 h after surgery, spermatic vein in male patients (spermatic vein diameter and spermatic vein blood flow velocity) before surgery and at 4 w after surgery, and recurrence rate within 1 year were compared between the two groups.

Results

The intraoperative blood loss, wound diameter, surgical time, ambulation time in TEP group were significantly less or shorter than those in TAPP group (P＜0.05).There was no significant difference in hospital stay between the two groups (P＞0.05).There was no statistical significance in the incidence of complications between TEP group (3.33%, 2/60) and TAPP group (6.67%, 4/60) (P＞0.05).There was interaction between groups and time on VAS scores in TEP group and TAPP group (P＜0.05).The main effect between groups and time on VAS was significant (P＜0.05).The levels of cortisol (Cor),aldosterone (ALD) and norepinephrine (NE) in both groups were significantly increased at 24 h after surgery than those before surgery (P＜0.05), but the levels of Cor, ALD and NE were significantly lower in TEP group than those in TAPP group after surgery (P＜0.05).At 4 w after surgery, the spermatic vein diameter of male patients in the two groups was significantly increased than that before surgery (P＜0.05),but the spermatic vein diameter was significantly lower in TEP group compared to TAPP group (P＜0.05).The blood flow velocity of spermatic vein in both groups was significantly declined than that before surgery (P＜0.05), but it was significantly higher in TEP group than in TAPP group (P＜0.05).There was no statistical significance in the recurrence rate between TEP group (5.00%, 3/60) and TAPP group (1.67%,1/60) (P＞0.05).

Conclusion

Laparoscopic TAPP and TEP are both effective in the treatment of inguinal hernia with few complications, but TEP has smaller trauma, faster recovery, and less impact on the spermatic vein of male patients, so it is necessary to select the appropriate surgery by the actual situation.