Lichtenstein术与腹腔镜经腹腹膜前腹股沟疝修补术的疗效、康复及成本效益对比

doi:10.3877/cma.j.issn.1674-392X.2026.02.013

目的

对比Lichtenstein术（局部麻醉）与腹腔镜经腹腹膜前修补术（TAPP，全身麻醉）在腹股沟疝治疗中的疗效、康复及成本效益。

方法

纳入2022年6月至2024年6月，遂宁市中医院及遂宁市中心医院收治的260例腹股沟疝患者资料，行回顾性对照研究。依据手术方式的不同分为Lichtenstein组（n=132）和TAPP组（n=128）。对比分析2组患者的手术效果、康复指标及费用。

结果

2组患者的基线资料均衡。两种术式在手术成功率、总体并发症发生率及术后1年复发率方面差异均无统计学意义（均P>0.05）。与TAPP组比较，Lichtenstein组手术时间更短[（55.8±11.0）min比（74.9± 12.4）min，P<0.001]，术后胃肠功能障碍发生率更低（0.8%比6.3%，P<0.05）；在术后恢复方面，其进食时间、下床活动时间及尿管留置率均显著优化（均P<0.05），患者满意度评分更高[（8.9±0.8）分比（7.2±1.1）分，P<0.05]；卫生经济学分析显示，其中位总费用显著降低（5510.4元比9261.3元，P<0.01），其中麻醉费用与材料费的降低最为显著。

结论

Lichtenstein术与TAPP术在手术成功率、总体并发症及复发率方面相当，但前者在手术效率、早期康复及卫生经济学效益方面具有综合优势。从多维度分析，Lichtenstein术仍是务实选择之一。

关键词: 疝，腹股沟, 疝修补术, Lichtenstein术, 腹腔镜, 经腹腹膜前修补术, 成本效益

Objective

To compare the efficacy, rehabilitation and cost-effectiveness of Lichtenstein hernia repair versus laparoscopic trans-abdominal preperitoneal repair (TAPP) for inguinal hernia treatment.

Methods

In this retrospective controlled study, clinical data of 260 patients with inguinal hernia who were admitted to Suining Hospital of Traditional Chinese Medicine and Suining Central Hospital between June 2022 and June 2024 were analyzed. According to the different surgical methods, they were divided into the Lichtenstein group (n=132) and the TAPP group (n=128). Surgical outcomes, postoperative recovery metrics, and costs of the two groups of patients were compared.

Results

Baseline characteristics were comparable between the two groups. Both techniques demonstrated equivalent surgical success rates and comparable rates of overall complications and 1-year recurrence (all P>0.05). Compared with the TAPP group, the Lichtenstein group had a shorter operation time [(55.8±11.0) vs. (74.9±12.4) minutes, P<0.001], lower incidence of postoperative gastrointestinal dysfunction (0.8% vs. 6.3%, P<0.05), and superior early recovery evidenced by shorter time to oral intake and ambulation, reduced urinary catheterization rate (all P<0.05), and higher patient satisfaction scores [(8.9±0.8) vs. (7.2±1.1), P<0.05]. Health economic analysis showed significantly lower median total costs for the Lichtenstein group (5510.4 Yuan vs. 9261.3 Yuan, P<0.01), driven predominantly by savings in anesthesia and material expenses.

Conclusion

Lichtenstein and TAPP repairs have comparable success rates, overall complications, and recurrence rates for inguinal hernia. The Lichtenstein approach offers distinct advantages in operative efficiency, enhanced early recovery, and significant cost savings. From a multi-dimensional perspective, the Lichtenstein procedure remains a practical option.

Key words: Hernia, inguinal, Herniorrhaphy, Lichtenstein repair, Laparoscopic, Transabdominal preperitoneal repair, Cost-effectiveness

表1 2组腹股沟疝患者的基线资料比较

项目	Lichtenstein组(n=132)	TAPP组(n=128)	χ²/t值	P值
年龄(岁, ±s)	55.6±12.1	54.9±11.5	0.477	0.662
性别[例(%)]			0.002	0.960
男性	127(96.2)	123(96.1)
女性	5(3.8)	5(3.9)
体重指数[例(%)]			0.273	0.873
<21 kg/m²	9(6.8)	7(5.5)
21~24 kg/m²	112(84.8)	109(85.2)
>24 kg/m²	11(8.3)	12(9.4)
劳动强度[例(%)]			0.363	0.834
强体力劳动	55(41.7)	50(39.1)
一般体力劳动	47(35.6)	45(35.2)
非体力劳动	30(22.7)	33(25.8)
疝位置[例(%)]			0.230	0.633
单侧	118(89.4)	112(87.5)
双侧	14(10.6)	16(12.5)
疝分类[例(%)]			0.183	0.912
斜疝	108(81.8)	107(83.6)
直疝	11(8.3)	9(7.0)
马鞍疝	13(9.8)	12(9.4)
疝环分类(直径)[例(%)]			0.159	0.924
Ⅰ型(<1.5 cm)	42(31.8)	43(33.6)
Ⅱ型(1.5~3.0 cm)	63(47.7)	61(47.7)
Ⅲ型(>3.0 cm)	27(20.5)	24(18.8)
合并症[例(%)]			0.243	0.902
呼吸系统	11(8.3)	9(7.0)
循环系统	13(9.8)	13(10.2)
代谢和(或)免疫系统	8(6.1)	9(7.0)
美国麻醉医师协会分级[例(%)]			0.011	0.918
Ⅰ级	60(45.5)	59(46.1)
Ⅱ级	72(54.5)	69(53.9)

表1 2组腹股沟疝患者的基线资料比较

项目	Lichtenstein组(n=132)	TAPP组(n=128)	χ²/t值	P值
年龄(岁, ±s)	55.6±12.1	54.9±11.5	0.477	0.662
性别[例(%)]			0.002	0.960
男性	127(96.2)	123(96.1)
女性	5(3.8)	5(3.9)
体重指数[例(%)]			0.273	0.873
<21 kg/m²	9(6.8)	7(5.5)
21~24 kg/m²	112(84.8)	109(85.2)
>24 kg/m²	11(8.3)	12(9.4)
劳动强度[例(%)]			0.363	0.834
强体力劳动	55(41.7)	50(39.1)
一般体力劳动	47(35.6)	45(35.2)
非体力劳动	30(22.7)	33(25.8)
疝位置[例(%)]			0.230	0.633
单侧	118(89.4)	112(87.5)
双侧	14(10.6)	16(12.5)
疝分类[例(%)]			0.183	0.912
斜疝	108(81.8)	107(83.6)
直疝	11(8.3)	9(7.0)
马鞍疝	13(9.8)	12(9.4)
疝环分类(直径)[例(%)]			0.159	0.924
Ⅰ型(<1.5 cm)	42(31.8)	43(33.6)
Ⅱ型(1.5~3.0 cm)	63(47.7)	61(47.7)
Ⅲ型(>3.0 cm)	27(20.5)	24(18.8)
合并症[例(%)]			0.243	0.902
呼吸系统	11(8.3)	9(7.0)
循环系统	13(9.8)	13(10.2)
代谢和(或)免疫系统	8(6.1)	9(7.0)
美国麻醉医师协会分级[例(%)]			0.011	0.918
Ⅰ级	60(45.5)	59(46.1)
Ⅱ级	72(54.5)	69(53.9)

表2 2组腹股沟疝患者手术效果比较

组别	例数	手术时间(min, ±s)	出血量[ml,M(Q₁,Q₃)]	日间手术达成率[例(%)]	术后住院时间[d,M(Q₁,Q₃)]	并发症[例(%)]
组别	例数	手术时间(min, ±s)	出血量[ml,M(Q₁,Q₃)]	日间手术达成率[例(%)]	术后住院时间[d,M(Q₁,Q₃)]	出血和(或)血肿	切口感染	胃肠功能障碍	慢性疼痛	总并发症
Lichtenstein组	132	55.8±11.0	5.0(3.0, 6.0)	115(87.1)	1.0(1.0, 1.3)	2(1.5)	1(0.8)	1(0.8)	0(0.0)	4(3.0)
TAPP组	128	74.9±12.4	5.0(4.0, 7.0)	110(85.9)	1.0(1.0, 1.1)	1(0.8)	1(0.8)	8(6.3)	1(0.8)	11(8.6)
t/Z/χ²值		-13.068^a	-1.165^b	0.078^c	0.297^b	-	-	-	-	3.700^c
P值		<0.001	0.244	0.857	0.767	1.000	1.000	0.018	1.000	0.054

表2 2组腹股沟疝患者手术效果比较

组别	例数	手术时间(min, ±s)	出血量[ml,M(Q₁,Q₃)]	日间手术达成率[例(%)]	术后住院时间[d,M(Q₁,Q₃)]	并发症[例(%)]
组别	例数	手术时间(min, ±s)	出血量[ml,M(Q₁,Q₃)]	日间手术达成率[例(%)]	术后住院时间[d,M(Q₁,Q₃)]	出血和(或)血肿	切口感染	胃肠功能障碍	慢性疼痛	总并发症
Lichtenstein组	132	55.8±11.0	5.0(3.0, 6.0)	115(87.1)	1.0(1.0, 1.3)	2(1.5)	1(0.8)	1(0.8)	0(0.0)	4(3.0)
TAPP组	128	74.9±12.4	5.0(4.0, 7.0)	110(85.9)	1.0(1.0, 1.1)	1(0.8)	1(0.8)	8(6.3)	1(0.8)	11(8.6)
t/Z/χ²值		-13.068^a	-1.165^b	0.078^c	0.297^b	-	-	-	-	3.700^c
P值		<0.001	0.244	0.857	0.767	1.000	1.000	0.018	1.000	0.054

表3 2组腹股沟疝患者术后康复情况比较

组别	例数	疼痛NRS评分(±s)		进食时间[h, M(Q₁,Q₃)]	下床活动时间[h, M(Q₁,Q₃)]	术后尿管留置[例(%)]	患者满意度评分(±s)	生存质量评分(±s)
组别	例数	术后1 d	术后7 d	进食时间[h, M(Q₁,Q₃)]	下床活动时间[h, M(Q₁,Q₃)]	术后尿管留置[例(%)]	患者满意度评分(±s)	生存质量评分(±s)
Lichtenstein组	132	2.0±0.89	0.25±0.53	0.9(0.6, 1.3)	1.6(1.4, 1.9)	1(0.8)	8.9±0.8	85.2±6.3
TAPP组	128	1.9±0.80	0.23±0.51	5.3(3.0, 8.1)	2.4(1.8, 3.5)	7(5.5)	7.2±1.1	83.7±7.1
t/Z值		0.450^a	0.365^a	12.1^b	8.3^b	-	15.67^a	1.89^a
P值		0.653	0.716	<0.001	0.012	0.034	0.010	0.064

表3 2组腹股沟疝患者术后康复情况比较

组别	例数	疼痛NRS评分(±s)		进食时间[h, M(Q₁,Q₃)]	下床活动时间[h, M(Q₁,Q₃)]	术后尿管留置[例(%)]	患者满意度评分(±s)	生存质量评分(±s)
组别	例数	术后1 d	术后7 d	进食时间[h, M(Q₁,Q₃)]	下床活动时间[h, M(Q₁,Q₃)]	术后尿管留置[例(%)]	患者满意度评分(±s)	生存质量评分(±s)
Lichtenstein组	132	2.0±0.89	0.25±0.53	0.9(0.6, 1.3)	1.6(1.4, 1.9)	1(0.8)	8.9±0.8	85.2±6.3
TAPP组	128	1.9±0.80	0.23±0.51	5.3(3.0, 8.1)	2.4(1.8, 3.5)	7(5.5)	7.2±1.1	83.7±7.1
t/Z值		0.450^a	0.365^a	12.1^b	8.3^b	-	15.67^a	1.89^a
P值		0.653	0.716	<0.001	0.012	0.034	0.010	0.064

表4 2组腹股沟疝患者住院费用比较[元，M（Q₁, Q₃）]

组别	例数	检查费	麻醉费	手术费	耗材费	药品费	其他费用	总费用
Lichtenstein组	132	1215.5(1215.5, 1215.5)	58.0(48.0, 58.0)	844.2(844.2, 844.2)	2298.0(2208.0, 2630.0)	154.3(145.0, 163.9)	876.8(831.0, 920.8)	5510.4(5330.9, 6076.5)
TAPP组	128	1215.5(1106.6, 1790.0)	952.0(952.0, 952.0)	962.0(962.0, 962.0)	4325.0(4270.5, 4825.0)	467.0(426.1, 523.7)	903.0(851.2, 958.0)	9261.3(8856.6, 9714.1)
Z值		-2.052	-15.182	-12.477	-13.889	-13.936	-3.33	-13.936
P值		0.040	<0.001	<0.001	<0.001	<0.001	0.001	<0.001

表4 2组腹股沟疝患者住院费用比较[元，M（Q₁, Q₃）]

组别	例数	检查费	麻醉费	手术费	耗材费	药品费	其他费用	总费用
Lichtenstein组	132	1215.5(1215.5, 1215.5)	58.0(48.0, 58.0)	844.2(844.2, 844.2)	2298.0(2208.0, 2630.0)	154.3(145.0, 163.9)	876.8(831.0, 920.8)	5510.4(5330.9, 6076.5)
TAPP组	128	1215.5(1106.6, 1790.0)	952.0(952.0, 952.0)	962.0(962.0, 962.0)	4325.0(4270.5, 4825.0)	467.0(426.1, 523.7)	903.0(851.2, 958.0)	9261.3(8856.6, 9714.1)
Z值		-2.052	-15.182	-12.477	-13.889	-13.936	-3.33	-13.936
P值		0.040	<0.001	<0.001	<0.001	<0.001	0.001	<0.001

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Comparison of efficacy, rehabilitation and cost-effectiveness between Lichtenstein hernia repair and laparoscopic trans-abdominal preperitoneal inguinal hernia repair

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Comparison of efficacy, rehabilitation and cost-effectiveness between Lichtenstein hernia repair and laparoscopic trans-abdominal preperitoneal inguinal hernia repair