探讨腹腔镜经腹腹膜前疝修补术（TAPP）与腹腔镜完全腹膜外疝修补术（TEP）治疗老年男性复发性腹股沟疝的疗效及对呼吸功能、睾丸血流动力学参数的影响。

选取2021年6月至2024年3月河北医科大学第二医院收治的老年男性复发性腹股沟疝患者104例，以随机数字表法分为TAPP组和TEP组，每组患者52例。对比2组患者围手术期指标、呼吸功能指标[气道压（Paw）、呼气末二氧化碳分压（P_ETCO₂）]、创伤反应指标[肿瘤坏死因子-α（TNF-α）、白细胞介素（IL）-1β、IL-6]、睾丸血流动力学参数[阻力指数（RI）、舒张期流速（EDV）、收缩期峰流速（PSV）]、并发症发生率及术后复发情况。

TEP组手术时间、术后疼痛持续时间均短于TAPP组，住院费用低于TAPP组，差异均有统计学意义（P均<0.05）；建立气腹10及30 min TEP组Paw、P_ETCO₂低于TAPP组，差异均有统计学意义（P均<0.001）；TEP组术后1、3 d血清TNF-α、IL-1β及IL-6水平低于TAPP组，差异均有统计学意义（P均<0.001）；TEP组EDV高于TAPP组，RI低于TAPP组，差异均有统计学意义（P均<0.001）；TEP组并发症发生率、术后1年复发率与TAPP组间，差异无统计学意义（P>0.05）。

TAPP、TEP是老年男性复发性腹股沟疝安全有效的治疗方案，但TEP对围术期呼吸功能影响较小，能减轻疼痛和创伤应激，减轻患者经济负担。

To investigate the clinical efficacy of transabdominal preperitoneal laparoscopic hernia repair (TAPP) versus totally extraperitoneal laparoscopic hernia repair (TEP) in elderly male patients with recurrent inguinal hernia, and their influences on respiratory function and testicular hemodynamic parameters.

A total of 104 elderly male patients with recurrent inguinal hernia admitted to the Second Hospital of Hebei Medical University from June 2021 to March 2024 were enrolled, and randomly divided into TAPP group and TEP group by the random number table method, with 52 cases in each group. The perioperative indicators, respiratory function indicators [airway pressure (Paw), end-tidal carbon dioxide partial pressure (P_ETCO₂)], trauma response indicators [tumor necrosis factor-α (TNF-α), interleukin (IL)-1β, and IL-6], testicular hemodynamic parameters [resistance index (RI), end-diastolic velocity (EDV), peak systolic velocity (PSV)], complication rates and postoperative recurrences of patients were compared between the two groups.

The operation duration and postoperative pain duration were shorter, and hospitalization costs were lower in the TEP group compared with the TAPP group, with statistically significant differences (all P<0.05). At 10 min and 30 min after pneumoperitoneum establishment, Paw and P_ETCO₂ values in the TEP group were significantly lower than those in the TAPP group (all P<0.001). Serum levels of TNF-α, IL-1β and IL-6 on postoperative day 1 and day 3 were markedly lower in the TEP group (all P<0.001). The TEP group had higher EDV and lower RI than the TAPP group (all P<0.001). No significant intergroup differences were found in the incidence of complications and 1year postoperative recurrence rate between the two groups (P>0.05).

TAPP and TEP are safe and effective treatment options for recurrent inguinal hernia in elderly males. However, TEP has a smaller impact on perioperative respiratory function, can alleviate pain and trauma stress, and reduces the economic burden on patients.