探究腹腔镜下腹膜前间隙补片修补术（LPPMR）对成人脐疝患者术后早期疼痛及生活质量的影响。

本研究为回顾性队列研究，对2023年6个月至2025年6个月在西安交通大学第一附属医院接受脐疝修补术已完成病例资料进行追溯性分析。根据患者入院时手术方式选择倾向及术者技术偏好分为LPPMR组（接受腹腔镜下腹膜前间隙补片修补术）、IPOM组（接受腹腔镜腹腔内补片修补术），2组各48例。比较2组手术相关指标、术后早期疼痛情况、术后腹壁肌肉功能、术后生活质量及随访结果。

LPPMR组手术时间显著多于IPOM组，但首次排气时间、手术费用显著少于IPOM组（P<0.05），术后24、48、72 h，1周，LPPMR组患者VAS评分均低于IPOM组；重复测量方差分析显示，时间效应（F=334.600，P<0.001）、组别效应（F=16.932，P<0.001）对术后早期疼痛作用显著，交互作用不显著（P>0.05）。术后1、3个月，LPPMR组平板支撑时间、仰卧静态卷腹时间及背桥个数均高于IPOM组；重复测量方差分析显示，时间、组别效应均对以上三项指标作用显著（P均<0.001），交互作用均不显著（P均>0.05）。术后1、3、6个月，LPPMR组生理领域、心理领域评分高于IPOM组；重复测量方差分析显示，时间效应对各领域评分作用显著（P<0.001），组别效应仅对生理领域（F=17.948，P<0.001）、心理领域（F=25.134，P<0.001）作用显著，而交互作用对以上四者作用均不显著（P均>0.05）。随访期间，2组患者均无复发。术后1个月，2组切口疼痛发生率分别为6.25%、20.83%，异物感发生率分别为4.17%、16.67%，LPPMR组切口疼痛、异物感发生率低于IPOM组（P<0.05）。2组并发症发生率比较，差异无统计学意义（P均>0.05）。

LPPMR、IPOM修补脐疝均安全有效，尽管LPPMR延长了手术时间，但其在减轻术后早期疼痛、促进腹壁功能恢复及提升近期生活质量方面均更具优势，对于追求快速康复及生活质量改善的患者可作为优选方案，但需权衡术者学习曲线及手术时间成本。

To evaluate the impact of laparoscopic preperitoneal mesh repair (LPPMR) on early postoperative pain and quality of life in adult patients undergoing umbilical hernia repair.

This is a retrospective cohort study. A retrospective analysis of the medical records of patients who underwent umbilical hernia repair at the First Affiliated Hospital of Xi 'an Jiaotong University between June 2023 and June 2025 was conducted. Patients were categorized into two groups based on surgical approach preference at admission and surgeon expertise: the LPPMR group (n=48), receiving laparoscopic preperitoneal mesh repair, and the IPOM group (n=48), receiving laparoscopic intraperitoneal onlay mesh repair. Comparative analyses were performed between the two groups on operative parameters, early postoperative pain levels, recovery of abdominal wall muscle function, postoperative quality of life, and follow-up outcomes.

Operative duration was significantly longer in the LPPMR group compared to the IPOM group. However, the LPPMR group demonstrated significantly shorter time to first flatus and lower overall surgical costs (P<0.05). Visual analog scale (VAS) pain scores assessed at 24, 48, 72 h, and 1 week postoperatively were lower in the LPPMR group than those in the IPOM group. Repeated- measures analysis of variance (ANOVA) indicated significant main effects for both time (F=334.600, P<0.001) and surgical group (F=16.932, P<0.001) on early postoperative pain, with no significant interaction (P>0.05). At 1 and 3 months after surgery, the LPPMR group exhibited superior performance in plank hold times, supine static crunch times, and number of bridge exercises than those in the IPOM group. The repeated measures ANOVA showed that the effects of time and group were significant for all the above three indicators (all P values<0.001), while the interaction effects were not significant (all P values>0.05). Furthermore, quality of life assessments at 1, 3, and 6 months after the surgery revealed significantly higher scores in both the physical and psychological domains for the LPPMR group than those of the IPOM group. Repeated-measures ANOVA showed significant time effects across all domains (P<0.001), with group effects significant only for the physical (F=17.948, P<0.001) and psychological (F=25.134, P<0.001) domains. The interaction effect had no significant effect on any of these four domains (all P>0.05). No hernia recurrences were reported in either group during follow-up. One month after the operation, the incidence of incision site pain (6.25% vs 20.83%) and foreign body sensation (4.17% vs 16.67%) was significantly lower in the LPPMR group than that in the IPOM group (P<0.05). The overall complication rates did not differ significantly between the two groups (P>0.05).

Both LPPMR and IPOM are safe and effective procedures for umbilical hernia repair. Although associated with a longer operative time, LPPMR offers distinct advantages, including reduced early postoperative pain, enhanced recovery of abdominal wall function, and improved short-term quality of life. LPPMR may serve as a preferred option for patients prioritizing rapid recovery and quality of life, though surgeon learning curve and operative time should be considered.