腹腔镜腹股沟疝修补术与Lichtenstein无张力疝修补术的前瞻性随机对照研究

Comparison between Laparoscopic Herniorrhaphy and Lichtenstein Repair for Inguinal Hernia:Randomized Controlled Trial

目的探讨腹腔镜腹股沟疝修补术和Lichtenstein无张力疝修补术的安全性、可行性及各自优缺点。方法采用前瞻性随机对照研究将2005年3月～2010年3月252例成人腹股沟疝采用信封法随机分成TAPP组(n=84)、TEP组(n=84)及Lichtenstein组(n=84),比较3组手术时间、术后疼痛评分、术后阴囊血清肿或积液、术后局部皮肤感觉障碍、术后慢性疼痛、术后远期疝复发及住院费用等。结果 168例腹腔镜手术均顺利完成,无中转开放手术。TAPP组和TEP组术后疼痛评分明显低于Lichtenstein组[(2.94±0.99)分vs.(4.25±0.46)分,q=16.434,P<0.05;(1.98±0.64)分vs.(4.25±0.46)分,q=28.477,P<0.05],住院费用明显高于Lichtenstein组[(9504±1132)元vs.(5852±864)元,q=33.481,P<0.05;(9351±985)元vs.(5852±864)元,q=32.079,P<0.05]。TAPP组和TEP组术后均无复发,显著低于Lichtenstein组4.8%(4/84)(P=0.012)。3组手术时间、术后阴囊血清肿或积液、术后局部皮肤感觉障碍、术后慢性疼痛无明显差异(P>0.05)。结论腹腔镜疝修补术,无论是TAPP还是TEP都是安全可行的,在术后疼痛评分、术后复发方面方面要明显优于Lichtenstein术式,但腹腔镜疝修补术手术费用较高。

Objective To compare the safety, feasibility, and advantages and limits of laparoscopic herniorrhaphy and Lichtenstein technique for inguinal hernia repair. Methods Since March 2005 to March 2010, a total of 252 patients were enrolled in this study. They were randomly divided into three groups to receive TAPP, TEP or Lichtenstein repair respectively （ n = 84 in each group）. The operation time, hospitalization cost, and postoperative pain score, scrotal seroma or esthesiodermia, local sensory disturbance, chronic pain, and long-term recurrent hernia rates of the three groups were compared. Results The procedures were completed in all the patients of the three groups without conversion to open surgery. The postoperative pain scores in the TAPP and TEP groups were significantly lower than that in the Lichtenstein group [2.94 ±0. 99 and 1.98 ±0. 64 vs. 4.25± 0.46, q = 16. 434 and 28. 477, respectively, both P 〈 0.05 ] , but the hospitalization costs of the TAPP and TEP groups were significantly higher than that in the Lichtenstein group [ （9504 ± 1132） RMB and （9351 ±985 ） RMB vs. （5852 ±864） RMB, q = 33.481 and 32. 079, respectively, both P 〈 0.05 ]. None patients from the TAPP and TEP groups had recurrence, while 4 of the 84 patients from the Lichtenstein group showed recurrent hernia （4.8%, P =0. 012）. No significant difference was observed among the three groups in operation time, postoperative scrotal seroma or esthesiodermia, local sensory disturbance, and chronic pain （P〉O. 05）. Conclusion Laparoscopic herniorrhaphy （either TAPP or TEP） is safe and feasible, and it is superior to Lichtenstein technique in improving postoperative pain and avoiding recurrence, but it is more expensive than the latter.