TAPP与Lichtenstein治疗成年男性双侧初发腹股沟疝的近期效果及安全性对比

doi:10.3877/cma.j.issn.1674-392X.2026.01.015

目的

探讨腹腔镜经腹腹膜前疝修补术（TAPP）与平片无张力疝修补术（Lichtenstein）治疗成年男性双侧初发腹股沟疝的近期效果及安全性。

方法

选取2021年5月至2024年3月河北医科大学第二医院108例成年男性双侧初发腹股沟疝患者作为研究对象，根据治疗方案分组，以1∶1配对方法选取患者，予以Lichtenstein术式治疗的54例纳入Lichtenstein组，TAPP术式治疗的54例纳入TAPP组。比较2组围手术期指标、术后并发症，以及术前及出院前1 d应激激素水平[皮质醇（Cor）、去甲肾上腺素（NE）、乙酰胆碱（ACH）]，术前及术后3个月血清睾酮及精子质量，术前及术后3个月勃起功能评分表（IIEF-5）、射精功能评分表（CIPE）及腹股沟疼痛调查问卷评分（IPQ），统计术后1年复发率。

结果

TAPP组术后24 h疼痛数字评分（NRS）（3.27±0.52）分，低于Lichtenstein组（6.69±1.27）分，术后下床时间、排气时间、住院时间分别为（15.37±2.69）h、（19.64±3.26）h、（3.69±0.87）d，均短于Lichtenstein组的（24.11±5.02）h、（26.87±5.51）h、（5.34±1.12）d，治疗费用（1.82±0.25）万元高于Lichtenstein组（1.36±0.19）万元（P<0.05）；TAPP组出院前1 d血清NE、ACH及Cor水平分别为（4.52±0.78）μg/L、（25.44±2.17）pg/ml、（598.41±37.24）mmol/L，低于Lichtenstein组的（5.11±0.82）μg/L、（28.63±2.27）pg/ml、（624.11±40.11）mmol/L，差异无统计学意义（P>0.05）；TAPP组手术时间、术后并发症、术后1年内复发率分别为（91.27±18.73）min、9.26%、1.85%，与Lichtenstein组（91.27±18.73）min、12.96%、3.70%比较，差异无统计学意义（P>0.05）；2组血清睾酮、精子浓度、精子总活力、精子畸形率、IIEF-5评分、CIPE评分、IPQ评分，术前与术后3个月比较，以及2组间比较，差异均无统计学意义（P>0.05）。

结论

Lichtenstein术式与TAPP术式治疗成年男性双侧腹股沟疝均有良好效果，且均对患者生殖系统无影响。TAPP术式在减轻应激反应、缓解疼痛、术后快速恢复方面更具优势，但其住院费用较高，临床可根据患者情况选择合适术式。

关键词: 疝，腹股沟, 疝修补术, 腹腔镜, 精子质量, 应激激素

Objective

To investigate the short-term efficacy and safety of laparoscopic trans-abdominal preperitoneal hernia repair (TAPP) and Lichtenstein's tension-free hernia repair (Lichtenstein) in the treatment of bilateral primary inguinal hernias in adult males.

Methods

A total of 108 adult male patients with bilateral primary inguinal hernia in The Second Hospital of Hebei Medical University from May 2021 to March 2024 were selected as the study subjects. According to the treatment regimens, patients were grouped and selected using a 1:1 matching method. The 54 patients who were treated with the Lichtenstein procedure were included in the Lichtenstein group, and the 54 patients who were treated with the TAPP procedure were included in the TAPP group. The perioperative indicators and postoperative complications were compared between the two groups, as well as the stress hormone levels [cortisol (Cor), norepinephrine (NE), acetylcholine (ACH)] before surgery and 1 day before discharge, the serum testosterone and sperm quality before and 3 months after surgery, the scores of International Index of Erectile Function -5 (IIEF-5), the Chinese Premature Ejaculation Questionnaire (CIPE), and the inguinal pain questionnaire (IPQ) before and 3 months after surgery. The recurrence rate at 1 year after surgery was analyzed.

Results

The postoperative 24-hour numerical rating scale (NRS) score in TAPP group was (3.27±0.52) points, which was lower than that in Lichtenstein group (6.69±1.27) points, the postoperative ambulation time, exhaust time and hospitalization time were (15.37±2.69) h, (19.64±3.26) h and (3.69±0.87) d, respectively, which were shorter than those in Lichtenstein group (24.11±5.02) h, (26.87±5.51) h and (5.34±1.12) d, the cost of treatment (1.82±0.25) ten thousand yuan was higher than that of Lichtenstein group (1.36±0.19) ten thousand yuan (P<0.05). The levels of serum NE, ACH and Cor in TAPP group 1 day before discharge were (4.52±0.78) μg/L, (25.44±2.17) pg/ml and (598.41±37.24) mmol/L, respectively, which were lower than those in Lichtenstein group [(5.11±0.82) μg/L, (28.63±2.27) pg/ml, (624.11±40.11) mmol/L], and the difference was not statistically significant (P>0.05). The operation time, postoperative complications and recurrence rate within 1 year after operation in TAPP group were (91.27±18.73) min, 9.26% and 1.85%, respectively, which were not significantly different from those in Lichtenstein group (91.27±18.73) min, 12.96% and 3.70% (P>0.05). There were no significant differences in serum testosterone, sperm concentration, total sperm motility, sperm malformation rate, IIEF-5 score, CIPE score, and IPQ score before surgery and three months after surgery, as well as between the two groups (P>0.05).

Conclusion

Both the Lichtenstein procedure and the TAPP procedure have demonstrated good efficacy in treating bilateral inguinal hernias in adult males, and neither procedure has any impact on the patient's reproductive system. The TAPP procedure has advantages in reducing stress response, alleviating pain, and facilitating rapid postoperative recovery. However, its hospitalization costs are relatively high. Clinically, appropriate surgical procedures can be selected based on the patient's condition.

Key words: Hernia, inguinal, Herniorrhaphy, Laparoscopes, Sperm quality, Stress hormone

表1 2组腹股沟疝患者一般资料比较

组别	例数	年龄(岁,±s)	体重指数(kg/m²,±s)	疝类型[例(%)]		疝囊直径(cm,±s)
组别	例数	年龄(岁,±s)	体重指数(kg/m²,±s)	直疝	斜疝	疝囊直径(cm,±s)
TAPP组	54	30.76±2.05	22.10±0.68	25(46.30)	29(53.70)	3.28±0.63
Lichtenstein组	54	31.01±2.36	22.23±0.75	28(51.85)	26(48.15)	3.35±0.71
t/χ²值		0.588	0.944	0.333		0.542
P值		0.558	0.348	0.564		0.589

表1 2组腹股沟疝患者一般资料比较

组别	例数	年龄(岁,±s)	体重指数(kg/m²,±s)	疝类型[例(%)]		疝囊直径(cm,±s)
组别	例数	年龄(岁,±s)	体重指数(kg/m²,±s)	直疝	斜疝	疝囊直径(cm,±s)
TAPP组	54	30.76±2.05	22.10±0.68	25(46.30)	29(53.70)	3.28±0.63
Lichtenstein组	54	31.01±2.36	22.23±0.75	28(51.85)	26(48.15)	3.35±0.71
t/χ²值		0.588	0.944	0.333		0.542
P值		0.558	0.348	0.564		0.589

表2 2组腹股沟疝患者围手术期指标比较（

±s）

组别	例数	手术时间(min)	术后24 h NRS评分(分)	术后下床时间(h)	术后排气时间(h)	住院时间(d)	治疗费用(万元)
TAPP组	54	91.27±18.73	3.27±0.52	15.37±2.69	19.64±3.26	3.69±0.87	1.82±0.25
Lichtenstein组	54	89.45±14.33	6.69±1.27	24.11±5.02	26.87±5.51	5.34±1.12	1.36±0.19
t值		0.567	18.313	11.277	8.299	8.550	10.765
P值		0.571	<0.001	<0.001	<0.001	<0.001	<0.001

表2 2组腹股沟疝患者围手术期指标比较（

±s）

组别	例数	手术时间(min)	术后24 h NRS评分(分)	术后下床时间(h)	术后排气时间(h)	住院时间(d)	治疗费用(万元)
TAPP组	54	91.27±18.73	3.27±0.52	15.37±2.69	19.64±3.26	3.69±0.87	1.82±0.25
Lichtenstein组	54	89.45±14.33	6.69±1.27	24.11±5.02	26.87±5.51	5.34±1.12	1.36±0.19
t值		0.567	18.313	11.277	8.299	8.550	10.765
P值		0.571	<0.001	<0.001	<0.001	<0.001	<0.001

表3 2组腹股沟疝患者术后并发症发生率比较[例（%）]

组别	例数	切口感染	切口血肿	腹股沟区麻木	阴囊水肿	总发生率
TAPP组	54	1(1.85)	3(5.56)	0(0.00)	1(1.85)	5(9.26)
Lichtenstein组	54	1(1.85)	1(1.85)	4(7.41)	1(1.85)	7(12.96)

表3 2组腹股沟疝患者术后并发症发生率比较[例（%）]

组别	例数	切口感染	切口血肿	腹股沟区麻木	阴囊水肿	总发生率
TAPP组	54	1(1.85)	3(5.56)	0(0.00)	1(1.85)	5(9.26)
Lichtenstein组	54	1(1.85)	1(1.85)	4(7.41)	1(1.85)	7(12.96)

表4 2组腹股沟疝患者术前及出院前1 d应激激素水平比较（

±s）

组别	例数	NE(μg/L)		ACH(pg/ml)		Cor(mmol/L)
组别	例数	术前	出院前1 d	术前	出院前1 d	术前	出院前1 d
TAPP组	54	5.74±1.12	4.52±0.78^a	35.26±2.87	25.44±2.17^a	662.43±44.83	598.41±37.24^a
Lichtenstein组	54	5.59±1.26	5.11±0.82^a	36.11±3.02	28.63±2.27^a	659.32±50.27	624.11±40.11^a
t值		0.654	3.831	1.499	7.465	0.339	3.451
P值		0.515	<0.001	0.137	<0.001	0.735	0.001

表4 2组腹股沟疝患者术前及出院前1 d应激激素水平比较（

±s）

组别	例数	NE(μg/L)		ACH(pg/ml)		Cor(mmol/L)
组别	例数	术前	出院前1 d	术前	出院前1 d	术前	出院前1 d
TAPP组	54	5.74±1.12	4.52±0.78^a	35.26±2.87	25.44±2.17^a	662.43±44.83	598.41±37.24^a
Lichtenstein组	54	5.59±1.26	5.11±0.82^a	36.11±3.02	28.63±2.27^a	659.32±50.27	624.11±40.11^a
t值		0.654	3.831	1.499	7.465	0.339	3.451
P值		0.515	<0.001	0.137	<0.001	0.735	0.001

表5 2组术前及术后3个月血清睾酮及精子质量比较（

±s）

组别	例数	睾酮(ng/ml)		精子浓度(×10⁶/ml)		精子总活力(%)		精子畸形率(%)
组别	例数	术前	术后3个月	术前	术后3个月	术前	术后3个月	术前	术后3个月
TAPP组	54	3.87±0.56	3.69±0.45	56.90±15.36	59.15±19.22	74.80±10.76	75.78±4.23	91.74±2.21	91.49±2.63
Lichtenstein组	54	3.89±0.61	3.70±0.49	56.47±16.22	59.07±18.41	74.92±11.02	75.67±4.19	91.80±2.49	91.55±2.84
t值		0.177	0.110	0.141	0.022	0.057	0.136	0.132	0.114
P值		0.859	0.912	0.888	0.982	0.954	0.892	0.895	0.910

表5 2组术前及术后3个月血清睾酮及精子质量比较（

±s）

组别	例数	睾酮(ng/ml)		精子浓度(×10⁶/ml)		精子总活力(%)		精子畸形率(%)
组别	例数	术前	术后3个月	术前	术后3个月	术前	术后3个月	术前	术后3个月
TAPP组	54	3.87±0.56	3.69±0.45	56.90±15.36	59.15±19.22	74.80±10.76	75.78±4.23	91.74±2.21	91.49±2.63
Lichtenstein组	54	3.89±0.61	3.70±0.49	56.47±16.22	59.07±18.41	74.92±11.02	75.67±4.19	91.80±2.49	91.55±2.84
t值		0.177	0.110	0.141	0.022	0.057	0.136	0.132	0.114
P值		0.859	0.912	0.888	0.982	0.954	0.892	0.895	0.910

表6 2组腹股沟疝患者术前及术后3个月IIEF-5、CIPE及IPQ评分比较（分，

±s）

组别	例数	IIEF-5评分		CIPE评分		IPQ评分
组别	例数	术前	术后3个月	术前	术后3个月	术前	术后3个月
TAPP组	54	15.74±3.02	15.92±3.17	32.49±4.83	33.04±5.12	8.12±1.54	1.72±0.41
Lichtenstein组	54	16.00±3.17	16.09±3.25	32.17±5.06	32.94±5.27	8.27±1.49	1.80±0.39
t值		0.436	0.275	0.336	0.100	0.514	1.039
P值		0.663	0.784	0.737	0.921	0.608	0.301

表6 2组腹股沟疝患者术前及术后3个月IIEF-5、CIPE及IPQ评分比较（分，

±s）

组别	例数	IIEF-5评分		CIPE评分		IPQ评分
组别	例数	术前	术后3个月	术前	术后3个月	术前	术后3个月
TAPP组	54	15.74±3.02	15.92±3.17	32.49±4.83	33.04±5.12	8.12±1.54	1.72±0.41
Lichtenstein组	54	16.00±3.17	16.09±3.25	32.17±5.06	32.94±5.27	8.27±1.49	1.80±0.39
t值		0.436	0.275	0.336	0.100	0.514	1.039
P值		0.663	0.784	0.737	0.921	0.608	0.301

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Comparison of short-term efficacy and safety of laparoscopic trans-abdominal preperitoneal hernia repair and Lichtenstein procedures for bilateral primary inguinal hernias in adult males

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Comparison of short-term efficacy and safety of laparoscopic trans-abdominal preperitoneal hernia repair and Lichtenstein procedures for bilateral primary inguinal hernias in adult males